Prevalence and correlates of psychological distress, unmet supportive care needs, and fear of cancer recurrence among haematological cancer patients during the COVID-19 pandemic

Abstract

Background The COVID-19 pandemic has had a disruptive effect on people with haematological cancers, who represent a high-risk population due to the nature of their disease and immunosuppressive treatments. We aimed to identify the psychological impacts of the COVID-19 pandemic on haematology patients and identify correlated factors to inform the development of appropriate supportive interventions. Methods Three hundred and ninety-four respondents volunteered their participation in response to a study advertisement distributed online through established haematology groups. Participants completed a self-report online survey exploring wellbeing, psychological distress, unmet supportive care needs, and fear of cancer recurrence. Results At least 1 in 3 respondents (35%) reported clinical levels of distress and nearly 1 in 3 (32%) identified at least one unmet need. Among respondents in remission (n = 134), clinical fear of cancer recurrence was reported by nearly all (95%). Unmet needs, pre-existing health conditions, younger age, financial concerns, and perceived risk of contracting COVID-19 were the dominant factors contributing to psychological distress during the pandemic. Psychological distress, lost income, perceived inadequate support from care team, perceived risk of contracting COVID-19, and being a woman were significantly associated with unmet needs. Psychological distress and concern about the impact of COVID-19 on cancer management were significantly associated with fear of cancer recurrence among respondents in remission. Conclusion Results highlight the high psychological burden and unmet needs experienced by people with haematological cancers during the COVID-19 pandemic and indicate a need for innovative solutions to rapidly identify distress and unmet needs during, and beyond, pandemic times.

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“… - interruption of RT is an independent predictor of FCR, but not for the postponement of RT. strong negative association between all 5 sub-components of quality of life (physical, role, emotional, cognitive, and social) and FCR, and both emotional (r = −.103, p˂.001 ) and social functioning (r = −.052, p=.006 ) were found to be independent predictors for high levels of FCR Limitations Possible recall bias Limited information regarding demographic variables No control group from the pre-pandemic period 6 Gultekin et al, 2020 16 European countries (France, UK, Italy, Spain, Greece, Turkey, Czech Republic, Germany, Netherlands, Denmark, Poland, Serbia, Hungary, Belarus, Ireland, Finland) 1st May – May 31, 2020 Prospective survey N = 1251 Gynecological cancer online and hard copy assessment Instruments Covid-19-related sections 1 item assessed the patients' concern about the progression of cancer due to the cancellation or postponement of treatment/follow-up HADS – anxiety and depression Two open-ended questions: 1 “What is the most challenging problem in this period?” 2 “Message that you want told to share about Covid-19 pandemic with ESGO, ENGAGe and Other International Organizations” No specification for stage, type, and histology of cancer Stage of treatment Type 1 = diagnosis of primary, or recurrent cancer scheduled for surgery Type 2 = receiving chemo, and/or radiotherapy for primary or recurrent disease Type 3 = Under routine oncologic follow-up Patients with previous psychiatric disorders, diagnoses unrelated to cancer and receiving medical treatment (e.g., bipolar, schizophrenia) were excluded Cancer related 71% of the assessed patients indicated that they were concerned about their cancer progression due to the possible cancellations and/or postponements of their treatment/follow-up FCR was investigated as a risk factor for abnormal HADS anxiety and HADS depression scores 1-item assessing the concern of concern progression due to cancellation/postponement of treatment/follow-up 7 [ 54 ] Australia 22nd July – August 19, 2020 Cross-sectional study Online assessment N = 394 hematological cancer Most common lymphoma and leukemia Inclusion criteria Adults older than 18 years of age Currently or previously diagnosed with hematological cancer Demographic variables: age, gender, postcode (residence) marital status, education level, employment status, Medical characteristics: Cancer care experience Financial concerns Concerns about the impact of COVID-19 on their own health and their perceived risk of contracting COVID-19 Psychological distre...…”

“…However, this study also has some serious limitations, as: the assessment of FCR with one single item, which did not permit the establishment of low, medium and clinically significant levels of FCR. Zomeredijk et al's [ 54 ] study was conducted on 394 hematological cancer - the most common forms being lymphoma (34%) and leukemia (27%). The major results of this investigation indicate that 35% of the sample reported elevated scores on the Kessler Psychological Distress Scale, 9% of them attaining severe levels of distress.…”

“…Zomeredijk et al's [ 54 ] study was conducted on 394 hematological cancer - the most common forms being lymphoma (34%) and leukemia (27%). The major results of this investigation indicate that 35% of the sample reported elevated scores on the Kessler Psychological Distress Scale, 9% of them attaining severe levels of distress.…”

“…All of the patients who had completed treatment and were in remission (n = 134), reported some degree of FCR, 95% of them reporting clinical levels of FCR. Psychological distress and concern about the impact of COVID-19 on cancer management were found to be significantly associated with greater FCR during the pandemic among hematological cancer patients in remission, explaining 28% of variance in FCR [ 54 ].…”

“…Moreover, age was the only risk factor for higher levels of fear of Covid-19 than of fear related to the oncological diagnosis, patients older than 70 years being more concerned about COVID-19 than about their cancer progression (Gultekin et al, 2020). Some studies [ 33 , 54 ] did not identify statistically significant differences in FCR depending on the assessed demographic variables, while others [ 49 , 51 ] presented limited information regarding results about the investigated demographic variables.…”