The cancer patient's perspective of COVID-19-induced distress-A cross-sectional study and a longitudinal comparison of HRQOL assessed before and during the pandemic

Cancer Med. 2021 Jun;10(12):3928-3937. doi: 10.1002/cam4.3950. Epub 2021 May 10.


Background: To permit timely mitigation of adverse effects on overall clinical outcome, it is essential to understand how the pandemic influences distress and health-related quality of life (HRQOL) in cancer patients during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: In this cross-sectional study, adult cancer patients, without COVID-19 symptoms, completed a 13-item questionnaire about the pandemic's impacts on distress and everyday-life; associations with age, sex, or impaired HRQOL were then assessed by binary logistic regressions. In a subsample of patients with HRQOL assessment available from both before and during the pandemic, we evaluated the pandemic's impact on longitudinal changes in HRQOL reported within 6 months before versus during the COVID-19 lockdown using McNemar's test, and thresholds for clinical importance.

Results: We consecutively enrolled 240 patients with solid (50%) or hematological (50%) cancers. Median age was 67 years, 46% were females. The majority ranked heeding their health (80%) and keeping their appointment schedule in hospital (78%) as important. Being younger than 60, or aged 60-70 was independently associated with limitations in everyday life (OR = 3.57, p < 0.001; and 2.05, p = 0.038); female individuals and those with restricted emotional functioning were more distressed by the COVID-19 situation (OR = 2.47, p = 0.040; and 3.17, p = 0.019); the latter group was also significantly more concerned about being a patient at risk (OR = 2.21, p = 0.029). Interestingly, in a subsample of patients (n = 47), longitudinal comparisons pre- versus during the pandemic revealed that HRQOL was not substantially affected by the pandemic.

Conclusion: Particularly younger and female cancer patients, and those with impaired emotional functioning are distressed by COVID-19. During the first COVID-19 lockdown, cancer patients remained predominantly resilient. This analysis highlights the need to mitigate distress situations in vulnerable patients and thereby enhance resilience during pandemics.

Keywords: cancer patients; corona virus disease 2019; distress; emotional well-being; health related quality of life; survey.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19 / epidemiology
  • COVID-19 / psychology*
  • COVID-19 / virology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neoplasms / psychology*
  • Pandemics
  • Quality of Life / psychology*
  • Risk Assessment / methods
  • Risk Assessment / statistics & numerical data
  • Risk Factors
  • SARS-CoV-2 / isolation & purification*
  • SARS-CoV-2 / physiology
  • Stress, Psychological / psychology*
  • Surveys and Questionnaires*