Impact of stopping therapy during the SARS-CoV-2 pandemic in persons with lymphoma

Abstract

Introduction: The severe acute respiratory syndrome-2 (SARS-CoV-2) pandemic disrupted medical care for persons with cancer including those with lymphoma. Many professional societies recommend postponing, decreasing or stopping anti-cancer therapy in selected persons during the pandemic. However, although seemingly sensible these recommendations are not evidence-based and their impact on anxiety and health-related quality-of-life (HRQoL) is unknown. Methods: Surveyed 2532 subjects including 1060 persons with lymphoma, 948 caregivers and 524 normal, uninvolved persons using a purposed-designed questionnaire on a patient organization website. Respondents also completed the Zung Self-Rating Anxiety and patient respondents, the EORTC QLQ-C30 instruments to quantify anxiety and HRQoL. We also evaluated caregiver support and an online education programme of the Chinese Society of Clinical Oncology (CSCO). Data of HRQoL from a 2019 pre-pandemic online survey of 1106 persons with lymphoma was a control. Results: 33% (95% Confidence Interval [CI] 30, 36%) of lymphoma patients and 31% (28, 34%) of caregivers but only 21% (17, 24%) of normal individuals had any level of anxiety (both pair-wise P < 0.001). Amongst lymphoma respondents physical exercise and better caregiver support were associated with less anxiety whereas female sex, receiving therapy and reduced therapy intensity were associated with more anxiety. Paradoxically, lymphoma respondents during the pandemic had better HRQoL than pre-pandemic controls. Reduced therapy intensity was associated with worse HRQoL whereas respondents who scored caregiver support and the online patient education programme high had better HRQoL. Conclusions: During the SARS-CoV-2 pandemic lymphoma patients and their caregivers had significantly higher incidence of anxiety compared with normals. Lymphoma respondents reported better HRQoL compared with pre-pandemic controls. Reduced therapy-intensity in patients with cancer may have unanticipated adverse effects on anxiety and HRQoL. Regular and intense support by caregivers and online education programmes alleviate anxiety and improve HRQoL.

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

“…These data suggest that persons with CML are psychologically vulnerable during the SARS-CoV-2 pandemic. Delay in monitoring response to TKI therapy, TKI therapy interruption, or dose reduction in persons with CML was associated with worse mental health in our study, consistent with the recent findings that treatment interruption, delay in cancer care, or reduced therapy intensity was associated with mental health problems and worse HRQoL in persons with cancer or lymphoma (12,13,(16)(17)(18)(40)(41)(42)(43). Fear of being infected with SARS-CoV-2 in the hospital or during travel as the common reason causing them not to follow the regular monitoring or cannot get TKI drugs in the hospital also reflected that they exaggerated the implementation of containment measures for avoidance of SARS-CoV-2 infection due to their psychological fragility.…”

“…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).…”

Counting the social, psychological, and economic costs of COVID-19 for cancer patients

“…Several studies reported anxiety amongst samples of all cancer patients during the pandemic [29,36,42,44]. Additionally, higher levels of anxiety were found amongst female patients in the UK, USA, Poland, and China [19,26,33,35,43,45]; patients from lower income households [11]; older and more vulnerable patients in the Netherlands and Northern Italy [18,30]; married patients in Singapore [36]; and patients with lower educational attainment in Italy, Singapore, and China [35,36,46]. In contrast, younger Chinese cancer patients demonstrated elevated levels of anxiety, suicide ideation, and low sleep quality, during the pandemic [47].…”

“…These strategies were an important predictor of QoL [20] and positive health behaviours. Positive lifestyle choices were likely to alleviate mental health burden and improve HRQoL [30,35,54], while others employed avoidance coping strategies, including self-distraction and substance use [62].…”

Impact of the COVID-19 pandemic on care and psychological impact on cancer patients

“…The main concerns of patients with cancer during the COVID-19 pandemic have been the following: COVID-19 infection, access to cancer care in those newly diagnosed, and cancer recurrence and progression due to delayed treatment [6–8]. The psychological effects of COVID-19 infection in patients with cancer requires greater attention from caregivers and organizations, as these patients are often more vulnerable to mental disorders than the general population [9,10 ▪▪ ,11].…”