(Ex-)breast cancer patients with (pre-existing) symptoms of anxiety and/or depression experience higher barriers to contact health care providers during the COVID-19 pandemic

Abstract

Purpose To identify factors associated with (perceived) access to health care among (ex-)breast cancer patients during the COVID-19 pandemic. Methods Cross-sectional study within a large prospective, multicenter cohort of (ex-)breast cancer patients, i.e., UMBRELLA. All participants enrolled in the UMBRELLA cohort between October 2013 and April 2020 were sent a COVID-19-specific survey, including the Hospital Anxiety and Depression Scale (HADS) questionnaire. Results In total, 1051 (66.0%) participants completed the survey. During COVID-19, 284 (27.0%) participants reported clinically relevant increased levels of anxiety and/or depression, i.e., total HADS score ≥ 12. Participants with anxiety and/or depression reported statistically significant higher barriers to contact their general practitioner (47.5% vs. 25.0%, resp.) and breast cancer physicians (26.8% vs. 11.2%, resp.) compared to participants without these symptoms. In addition, a higher proportion of participants with anxiety and/or depression reported that their current treatment or (after)care was affected by COVID-19 compared to those without these symptoms (32.7% vs. 20.5%, resp.). Factors independently associated with symptoms of anxiety and/or depression during COVID-19 were pre-existent anxiety (OR 6.1, 95% CI 4.1–9.2) or depression (OR 6.0, 95% CI 3.5–10.2). Conclusion During the COVID-19 pandemic, (ex-)breast cancer patients with symptoms of anxiety and/or depression experience higher barriers to contact health care providers. Also, they more often report that their health care was affected by COVID-19. Risk factors for anxiety and/or depression during COVID-19 are pre-existent symptoms of anxiety or depression. Extra attention—including mental health support—is needed for this group.

The psychosocial and emotional experiences of cancer patients during the COVID-19 pandemic: A systematic review

“…The most common emotional aspects explored in these studies were anxiety and depression using a wide variety of tools ( Table 1 ). Most studies reported increased levels of anxiety and depression, but comparators were not always clear or comparable across the studies [ 29 ; [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] ].…”

“…During the COVID-19 pandemic, some contributing factors to worsening emotional status or quality of life included being younger and female [52] , having advanced disease [ 34 ; 61 ] and delays in oncology care [ 41 ; [44] , [45] , [46] , [47] ; 62 ]. On the other hand, an internal locus of control and strong family resilience mitigated the negative impact on emotional functioning [63] , [64] .…”

The psychological impact of COVID‐19 among newly diagnosed patients with breast cancer when cancer care was returning to normal

“…There were 51.8% and 44.0% of patients during the pandemic reported symptoms of anxiety and depression, respectively. In previous studies, the prevalence of anxiety symptoms in patients with breast cancer during the COVID‐19 pandemic ranged from 18.2% to 67.7% and 16.0% to 53.0% for depressive symptoms (Chen et al, 2021 ; Cui et al, 2020 ; Juanjuan at al., 2020 ; Kim & Kim, 2022 ; Massicotte et al, 2021 ; Mink van der Molen et al, 2021 ). The variety of the prevalence may result from the different criteria used to define anxiety and depressive symptoms and the different treatment stages of the patients.…”

“…In a qualitative study of breast cancer patients undergoing treatment, the patients reported increased psychological distress and worries, such as a higher risk of catching COVID‐19, changes in cancer care and decreased family relationships (Savard et al, 2021 ). Quantitative studies found that the prevalence of symptoms of anxiety was 18.2%–67.7% (Chen et al, 2021 ; Cui et al, 2020 ; Juanjuan et al, 2020 ; Kim & Kim, 2022 ; Massicotte et al, 2021 ; Mink van der Molen et al, 2021 ) and depressive symptoms were 16.0%–53.0% (Chen et al, 2021 ; Cui et al, 2020 ; Juanjuan et al, 2020 ; Kim & Kim, 2022 ; Massicotte et al, 2021 ; Mink van der Molen et al, 2021 ) among patients with breast cancer during the COVID‐19 pandemic, which were much higher than the prevalence of symptoms of anxiety and depression in the general population during the pandemic (Cenat et al, 2021 ; Lakhan et al, 2020 ; Salari et al, 2020 ). Besides increased anxiety and depression, patients with breast cancer also experience high levels of fear of cancer progression (Kim & Kim, 2022 ; Koral & Cirak, 2021 ; Massicotte et al, 2021 ; Soriano et al, 2021 ; Xie et al, 2021 ).…”

Mental Health in Persons With Chronic Myeloid Leukemia During the SARS-CoV-2 Pandemic: The Need for Increased Access to Health Care Services

“…There are many reports of increased prevalence and severity of mental health problems including those of depression, anxiety, and distress during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic in the general population, medical health care workers (1)(2)(3)(4)(5)(6)(7)(8)(9), and persons with chronic diseases (10,11). Several studies reported that cancer patients experienced mental health problems or worse healthrelated quality of life (HRQoL) (12)(13)(14)(15)(16)(17)(18)(19)(20)(21), which were associated with delay in cancer care or reduced therapy intensity. However, the impact of the pandemic on the mental health of persons with leukemia is rare, and there is none in persons with chronic myeloid leukemia (CML).…”