The cost of living with cancer during the second wave of COVID-19: A mixed methods study of Danish cancer patients' perspectives

Abstract

This study investigated experiences and levels of distress and resilience of Danish cancer patients during the second wave of the COVID-19 pandemic. Methods: The mixed methods design included a subset of cancer patients who responded to a cross-sectional survey in May 2020. Data were collected through telephone interviews. The National Comprehensive Cancer Network Distress Thermometer (NCCN DT), and Connor-Davidson-Resilience Scale (CD-RISC2) were used to measure distress and resilience. Data were analysed by thematic analysis and descriptive statistics. Results: Forty patients with lung, breast, colorectal and skin (melanoma) cancer were included; 65% were women. Mean age was 62.2 years (standard deviation [SD], 13.2). Most patients had curable disease (65%); 50% were in treatment and 50% in post-treatment follow up. The interviews revealed four themes: 1) the cost of living with cancer during COVID-19, 2) changes in cancer care delivery, 3) particularly vulnerable, and 4) importance of family support. Mean NCCN DT score was 2.3 (SD, 2.6) while the mean CD-RISC2 score was 7.25 (SD, 1.1). Conclusion: Despite drastic changes in daily life imposed by COVID-19 restrictions, Danish cancer patients had remarkably low levels of distress and high levels of resilience. Patients in active treatment, with comorbidities or elderly felt vulnerable. Family support was invaluable in critical times.

Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective

“…Increased prevalences of psychological disorders during the COVID-19 pandemic and decline in psychological wellbeing have been described similarly to our results [ 28 , 29 ]. Other studies reported higher rates [ 30 , 31 , 32 , 33 ], but used instruments targeting different aspects of distress.…”

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

“…Hamlish and Papautsky (2020) [53] reported higher levels of distress in White breast cancer patients compared to Non-white participants. In contrast, other research teams found that levels of distress among cancer patients were lower or no different than before the pandemic [ 19 ; 31 ; [54] , [55] , [56] ]. Even more, one study found no difference in anxiety or depression levels in cancer patients compared to the general population during the COVID-19 pandemic [57] .…”

“…Studies used many different outcome measures in their cross-sectional designs ( Table 1 ). Six studies employed a qualitative methodology [23] , [24] , [25] , [26] , [27] , [28] and four study used mixed methods [29] , [30] , [31] , [32] .…”

“…The guidelines on working from home and social distancing introduced across most of the world meant that many patients experienced a higher level of anxiety about going or returning to work [26] . Although financial hardship hit many of the population, cancer patients are known to have a higher financial burden pre-pandemic [ 28 ; 31 ; 38 ; 45 ; 59 ; 65 ].…”

“…Inherently linked to the COVID-19 restrictions was the sense of loneliness and isolation [ [25] , [26] , [27] ; 30 ; 32 ; 36 ; 45 ; 48 ; [56] , [57] , [58] , [59] ; 66 58 ]. Equally, the importance of social support from family and friends was highlighted in several studies [ 24 ; 26 ; [30] , [31] ; 63 ]. The COVID-19 pandemic also accentuated uncertainty about the future for cancer patients in several studies [ 26 ; 30 ; 32 ; 68 ].…”