“I Have Constant Fear”: A National Qualitative Study on the Impact of COVID-19 on Cancer Care and Potential Solutions to Improve the Cancer Care Experience During the COVID-19 Pandemic

Abstract

PURPOSE: The COVID-19 pandemic has greatly affected cancer care delivery for patients, including cancellation or delays in surveillance imaging, clinic visits, and treatments. Yet, gaps remain in understanding the extent of the impact of the COVID-19 pandemic on patients with cancer and potential ways to overcome these impacts. METHODS: We conducted semistructured, in-depth, one-on-one qualitative interviews among adults with a past or current history of cancer in the United States. Participants from a parent quantitative survey were purposively sampled to participate in a qualitative interview. Interview questions addressed (1) experiences with cancer care delivery during the COVID-19 pandemic; (2) unmet concerns regarding care and other impacts; and (3) approaches to improve patient experiences. We conducted inductive thematic analysis. RESULTS: Fifty-seven interviews were conducted. Four themes emerged: (1) concern regarding the risk of COVID-19 infection among patients with cancer and their families; (2) disruptions in care increased patients' anxiety about poor cancer outcomes and death from cancer; (3) significant social and economic impacts; and (4) increased social isolation and anxiety about the future. Suggestions for current clinical practice include (1) clear communication on patients' health risks; (2) increased attention to mental health needs and access to mental health services; and (3) routine use of telemedicine as frequently as possible when clinically appropriate. CONCLUSION: These rich findings reveal the significant impact of the COVID-19 pandemic on patients with cancer and potential approaches to mitigate the impact from the patient perspective. The findings not only inform current cancer care delivery but also health system responses to future public health or environmental crises that may pose a unique health risk for patients with cancer or disrupt their care.

“You matter”: patients perceptions and disparities about cancer care and telehealth during and after COVID-19 pandemic

“…While patients with cancer have been reported to have amplified stress [ 29 , 30 ], this could have been exacerbated due to the COVID-19 pandemic [ 15 , 31 , 32 ]. This analysis identified additional significant disparities in receiving access to mental health services based on education status.…”

Telehealth and Outcomes in Patients With Cancer

“…3 The promise of telehealth utilization in mitigating the unfavorable effects of COVID-19 on patients with cancer was realized by oncology providers, patients, and regulators alike, leading to swift changes that facilitated rapid implementation at some centers. [3][4][5][6][7] Before the drastic increase in telehealth utilization during the COVID-19 pandemic, telehealth benefits were demonstrated in specific settings to hasten diagnosis and initiation of treatment in patients with cancer, reduce the inconvenience and financial burden of traveling for care, and facilitate remote monitoring to enhance communication between patients and oncology providers. [8][9][10][11] However, wide-scale expansion of programs to facilitate telehealth implementation requires that we systematically study this intervention in the context of meaningful outcomes relevant to patients, practitioners, and the entire health care system.…”

“…Unsurprisingly, the pandemic has also led to heightened distress among patients with cancer for various reasons 3 . The promise of telehealth utilization in mitigating the unfavorable effects of COVID-19 on patients with cancer was realized by oncology providers, patients, and regulators alike, leading to swift changes that facilitated rapid implementation at some centers 3–7 . Before the drastic increase in telehealth utilization during the COVID-19 pandemic, telehealth benefits were demonstrated in specific settings to hasten diagnosis and initiation of treatment in patients with cancer, reduce the inconvenience and financial burden of traveling for care, and facilitate remote monitoring to enhance communication between patients and oncology providers 8–11 .…”

“…These are likely to have yet unrealized effects on long-term clinical outcomes in patients with cancer. Unsurprisingly, the pandemic has also led to heightened distress among patients with cancer for various reasons 3 . The promise of telehealth utilization in mitigating the unfavorable effects of COVID-19 on patients with cancer was realized by oncology providers, patients, and regulators alike, leading to swift changes that facilitated rapid implementation at some centers 3–7 .…”