Anxiety and depression in cancer patients and survivors in the context of restrictions in contact and oncological care during the COVID‐19 pandemic

Sir, Lung cancer is one of the most common malignancies occurring in the world. Western literature describes varying rates (11-44% prevalence) of depression in patients with carcinoma of the lung.[12] Expensive prolonged therapy, lack of health insurance, low social and economic status, and low educational background are additional risk factors for the development of depression, especially in developing countries. Prevalence of depression in lung cancer patients remains unexplored in developing countries like ours. Here, we report prevalence of depression in a cross-sectional sample these patients. The sample included 100 consecutive patients with a biopsy-confirmed diagnosis of lung cancer who visited a Department of Pulmonology in a private tertiary care general hospital in Bengaluru, India, between September 2009 and October 2011. The diagnoses included adenocarcinoma, small cell carcinoma, large cell carcinoma, squamous cell carcinoma, and metastatic lung tumors. The Hamilton depression rating scale (HDRS) was administered to all patients. Patients with a score 7 or more were considered to be “cases” of depression.[3] HDRS has been shown to have good psychometric properties for screening of depression in cancer patients.[4] Study was approved by Institutional Ethics Committee. There were 74 males and 26 females in our study. Mean age was 59.05 years (SD = 12.4). Mean HDRS score was 10 (SD = 1.6). The prevalence of depression was 28% (mild = 26%, moderate = 2%). Recent proton magnetic resonance spectroscopy has shown that brain metabolism is altered in lung cancer patients even before initiation of treatment. Studies have also shown that inflammatory cytokines are elevated in these patients.[5] These changes might have an important role in alteration of cognitive functions and causation of depression. Recent report from International Federation of Psycho-Oncology Societies reported that psycho-oncology is not well-established in a developing country and there is a need to enhance integration of psychological care with oncological care.[6] In order to plan such intervention there is a need for more research in this area. Our data adds to the existing literature on the prevalence of depression in cancer. Although prevalence in our sample is comparable to the developed world data, psycho-oncology care is neglected in our country. Certain limitations should be kept in mind while interpreting this result. HDRS may not be good tool to assess depression in medically ill. In particular, loss of appetite, insomnia, fatigue, weight loss may be secondary to medical pathology rather than manifestation of depression. Further studies are needed to develop proper scale to evaluate depression in cancer patients. This study brings to notice important clinical issue consultation liaison psychiatry. Further prospective studies are urgently needed to study depression in lung cancer. There is a need to establish robust clinical programs and research in psycho-oncology, especially in developing countries. Comprehensive psycho-oncology service wing establishment is required, especially in cancer care centers.

Background and Purpose: Until a vaccine is widely available, adherence to COVID-19 preventive behaviors is the most effective way to prevent the spread of the COVID-19 pandemic. While there is a general paucity of information on COVID-19 infection and its impact on cancer patients, immunocompromised individuals, such as cancer patients, are likely at greater risk for both COVID-19 morbidity and mortality. In addition, a cancer diagnosis can cause stress, anxiety, depression, psychological distress, and poor quality of life. While the recommendations for COVID-19 parallel the common recommendations for managing infection risk, the enhanced social isolation and limited social distancing can be even more difficult for patients resulting in increased risk for psychological distress and deteriorations in health outcomes. Depressive disorders frequently result in substantial functional impairment, as well as increased emotional, economic, and productivity costs. It is important to understand how the COVID-19 pandemic impacts psychological and psychosocial factors, as well as health behaviors of cancer patients and survivors, and how various contextual factors may play risk and protective roles. The purpose of this study, therefore, is to determine differences in stress, mental health and coping behaviors, and adherence to COVID-19 preventive behaviors during the COVID-19 pandemic among three groups of adults (in active cancer treatment, cancer survivors, and those without a history of cancer). This study focuses on determining how sociodemographic characteristics and cancer status influence COVID-19 mental health/coping mechanisms, as well as how mental health/coping mechanisms and cancer status may predict adherence to preventive COVID-19 behaviors. Methods: Panel survey firm Qualtrics was used to administer an online survey among 897 U.S. adults in May of 2020. Quota sampling was utilized to ensure a sample consisting of approximately one-third: cancer patients currently in treatment (32.0%, n = 287), cancer survivors not currently in treatment (33.6%, n=301), and respondents with no cancer history (34.4%, n = 309). Survey items assessed demographic variables, depression, coping, and adherence to COVID-19 preventive behaviors. Results and Discussion: Preliminary analyses show that cancer patients report higher levels of depressive symptoms than survivors and the control group. In addition, cancer patients in active treatment use both avoidance and approach-focused coping more frequently than both survivors and the control group. Regression analyses show that avoidance coping predicts lower adherence to COVID-19 preventive behaviors, while approach-focused coping predicts higher adherence. Analyses are ongoing. Citation Format: Jeanine P.D. Guidry, Carrie A. Miller, Bernard F. Fuemmeler. Mental health and coping during COVID-19 among cancer patients and survivors [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P41.

Informing Patient Surveillance for the Growing Number of Survivors of Lung Cancer

Background: Breast cancer is the most diagnosed cancer in women and a leading cause of cancer-related morbidity. Active treatments, such as chemotherapy, radiation, and targeted therapies, are frequently associated with fatigue, reduced physical activity, and decreased quality of life. Wearable activity trackers, including fitness bands and smartwatches, are increasingly being integrated into oncology care to track physical activity, monitor symptoms, and enhance patient engagement. Their use during active treatment provides new opportunities for behavioral support and real-time, remote monitoring. This study systematically examines the use of wearable activity trackers during active breast cancer treatment to monitor activity, track symptoms, support adherence, and enhance patient engagement. MethodsA comprehensive search using relevant keywords and MeSH terms related to ‘breast cancer’, ‘breast cancer treatment’, and ‘activity trackers’ was conducted until March 2025 across PubMed/Medline, Scopus and Web of Science. Studies that used wearable activity trackers in adult breast cancer patients receiving active treatment as part of clinical care or research were included. Data were systematically extracted on how activity trackers were used during active treatment and their intended purposes. The findings were synthesized narratively. Results: The final analysis comprised 40 studies involving over 8,000 participants. The included studies comprised of observational studies (prospective, longitudinal, and cohort) (n=25), randomized controlled trials (n=9), cross-sectional studies (n=4), and non-randomized interventional studies (n=3). Most studies (n = 18) were conducted in the United States. The most common wearable tracker was FitBit. Wearables were primarily used to track physical activity, assess symptoms such as fatigue and sleep issues, and enhance patient engagement and treatment adherence. 23 studies (57.5%) assessed physical activity, 18 (45%) studies assessed sleep, 10 (25%) studies evaluated fatigue, and 9 studies (22.5%) examined quality of life. 21 studies described adherence outcomes, with adherence rates ranging from roughly 16.9% to 96%, while 23 studies (57.5%) reported feasibility outcomes. The duration of time using wearables varied across studies. Conclusion: This study demonstrated that wearable activity trackers are practical and can be effectively utilized during active breast cancer treatment to monitor physical activity, sleep, and fatigue, while also supporting patient engagement and adherence. Most studies demonstrated high feasibility and acceptable adherence rates, underscoring the potential of these devices to enhance supportive care. With technological advancements, wearable trackers offer the potential for real-time detection of treatment-related toxicities and delivery of personalized interventions. Future research is needed to validate wearable-derived metrics and support their integration into clinical decision-making pathways, thereby optimizing outcomes in breast cancer care. Other future directions include leveraging wearables for tracking lymphedema, monitoring long-term cardiac health following anthracycline exposure, and evaluating toxicity profiles associated with the rise of HER2-targeted antibody-drug conjugates. However, key challenges remain, including data overload, limited integration with electronic medical records, and persistent issues of equity and access. Collaborating with companies to incorporate wearable data collection in clinical trials may help address these barriers, while efforts to ensure rigorous validation and standardization of wearable technologies will be critical to their successful adoption in routine oncology care. Citation Format: J. Hundal, S. Peshin, F. Bashir, H. Bazroodi, E. Takrori, M. Kurian. Use of Wearable Activity Trackers During Active Breast Cancer Treatment: A Systematic Review [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-04-26.

Background: This present study examined the prevalence and association of psychiatric disorders including hospital anxiety, stress, and depression, positive and negative affect in breast cancer patients. Furthermore, this study also investigated moderating role of emotional regulation on the relationship between hospital anxiety, and symptoms of stress, anxiety and depression. Methods: Purposive sampling technique was used bases on cross-sectional study design. One hundred fifty-five diagnose patients with breast cancer were recruited from different hospitals as the Noori Hospital, Islamabad, Pakistan Institute of Medical Sciences, Islamabad, Kulsoom International Hospital and Combined Military Hospital, Rawalpindi, Pakistan from August, 2019 to January, 2020 . The participant’s age ranges from 20 to 50 years old (M=35.00, SD=2.01). Four standardized instruments were performed to examine the prevalence of hospital anxiety, stress, depression, anxiety, emotional regulation, positive and negative mood swings in patients with breast. Results: Correlational and moderation analysis was performed to analyze data of study. This study’s results demonstrated that hospital anxiety was positively associated with psychological distress, anxiety and depression in breast cancer patients. Moreover, results of current study revealed that emotional regulation was negatively related to higher level of negative mood and hospital depression in cancer patients. Moreover, Finding also demonstrated that emotional regulation was playing role of moderator between overall hospital anxiety and emotional regulation in breast cancer patients. Moderation analysis found that hospital anxiety was associated with lower level of stress because it favors of higher prevalence of emotional regulation in breast cancer patients. Conclusions: The results of this study will be very helpful in hospitals for evaluation psychiatric features such as depression, anxiety and stress in breast cancer patients. But still there is a need to discover other psychological factors relating this study.

Introduction: Cancer patients are more susceptible to infections, and infection can be more severe than in patients without cancer diagnosis. We conducted this retrospective study in patients admitted for SARS-CoV-2 infection in order to find differences in inflammatory markers and mortality in cancer patients compared to others. Methods: We reviewed the electronic records of patients admitted for SARS-CoV-2 infection confirmed by PCR from March to September 2020. Data on socio-demographics, comorbidities, inflammatory makers, and cancer-related features were analyzed. Results: 2,772 patients were admitted for SARS-CoV-2, to the Hospital Universitario Ramón y Cajal in Madrid during this period. Of these, 2,527 (91%) had no history of neoplastic disease, 164 (5.9%) patients had a prior history of cancer but were not undergoing oncological treatment at the time of infection, and 81 (2.9%) were in active treatment. Mortality in patients without a history of cancer was 19.5%, 28.6% for patients with a prior history of cancer, and 34% in patients with active cancer treatment. Patients in active oncology treatment with the highest mortality rate were those diagnosed with lung cancer (OR 5.6 95% CI: 2.2–14.1). In the multivariate study, active oncological treatment (OR 2.259 95% CI: 1.35–3.77) and chemotherapy treatment (OR 3.624 95% CI: 1.17–11.17), were statistically significant factors for the risk of death for the whole group and for the group with active oncological treatment, respectively. Conclusion: Cancer patients on active systemic treatment have an increased risk of mortality after SARS-CoV-2 infection, especially with lung cancer or chemotherapy treatment.

Introduction and Objectives: Cancer patients are more susceptible to infections because of the active treatment that they need to treat their disease. A new coronavirus, called SARS-CoV-2, has caused a global pandemic where cancer patients have an increased risk of morbidity and mortality associated with COVID-19. However, the incidence data of COVID-19 in cancer patient with active treatment are not known, although the main oncology societies recommend a delay and/or stop in active cancer treatment during this pandemic. Whether this stop will have an impact on the future evolution of their disease is also not known. Therefore, a study of the incidence of COVID-19 in this type of patient can help us to organize the protocols and the treatment in these high-risk patient group. Materials and Methods: We conducted a prospective clinical study of cancer patients within active treatment (chemotherapy, palliative hormonotherapy, radiotherapy, target therapies, or immunotherapy), analyzing the number of COVID-19 diagnoses between February 26 and May 13 in two oncology services of the Andalusian community. A descriptive analysis of 692 patients with active treatment was carried out. In addition, the cumulative incidence and the differences between groups were calculated using the SPSS vs 18. Results: A total of 692 cancer patients undergoing active treatment at the Hospital Costa del Sol (Marbella) and at the Hospital San Cecilio (Granada) were analyzed. Sixty four percent were men with a mean age of 60 years. Forty one percent had a breast cancer diagnosis, 12.9% had lung cancer, and 14.5% had colorectal tumor. Fifty three percent of them received treatment for stage IV disease, and up to 43% were delayed treatment due to pandemic. The total number of infections was 9, a cumulative incidence of 1.3%, 95% CI (0.384-2.217), and 22% of them died after developing the infection. Advanced age (p = 0.011), an admission in the 3 months prior to the diagnosis of COVID-19 (p = 0.031), and active treatment with chemotherapy (p = 0.003) were the factors that were associated with an increased risk of developing COVID-19. Conclusions: The incidence of SARS-CoV-2 in cancer patients on active treatment is low but the mortality is high, as previously reported for these patients. Given that the incidence of COVID-19 in patients with treatment is low, we cannot conclude any role of treatment delay in the development of COVID-19 in these patients. Citation Format: Celia Martin Bravo, Isabel Blancas López-Barajas, Raúl Quirós López, Marta Robles Lasarte, Rosa Villatoro Roldán, Julia Alcaide García, Victor Navarro Pérez, Diego Perez Martín, Irene Zarcos Pedrinaci, Elisa Mañas Mora, Nicolás Jiménez García, Santiago Vico Cabra, Irati de Urrutia Undabarrena, Isabel Barragan Mallofret, Cristina Quero Blanco, Elisabeth Pérez-Ruiz. Incidence of SARS-COV-2 infection in cancer patients undergoing active treatment [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-024.

Background/objectives: Cancer patients are more vulnerable to SARS-CoV-2 infection and COVID-19 due to their immunocompromised status. This study aims to evaluate the risk of SARS-CoV-2 infection, as well as COVID-19 prevalence and mortality, in cancer patients during the first wave of the COVID-19 pandemic in a virus epicenter of Northern Italy. Methods: This retrospective analysis included 40,148 prevalent cancer patients from the province of Parma, Italy, between February and June 2020. Patients were identified from health system records and classified by cancer subtype, treatment status, and COVID-19 diagnosis. The risk of infection and mortality was analyzed using odds ratios (OR) and hazard ratios (HR). Results: Among cancer patients, those on active cancer treatment had a higher cumulative risk of all-cause death (HR 1.83, p < 0.000268). Cancer subtype significantly impacted COVID-19 outcomes, with breast cancer patients showing lower incidence and mortality compared to those with lung, colorectal, or bladder cancers. Conclusions: Cancer patients, especially those on active treatment, are at increased risk of COVID-19 infection and death. Tailored prevention strategies, including prioritization of vaccination and careful management of cancer treatments, are crucial to mitigate risks during pandemics. These findings provide valuable insights for clinical decision-making in oncological care during public health crises.

Radiotherapy and COVID-19: Practical recommendations from iran

İntroduction and aim: Cancer affects people psychologically and organically. The emotional state of cancer patients is fragile and can be affected by many factors. We aimed to evaluate the effect of the Covid-19 pandemic on the mood and behavioral changes of cancer patients with solid cancer who are in follow-up and treatment. Material and Method: A face-to-face questionnaire was filled in solid cancer patients without known psychological disorders who applied to the Medical Oncology outpatient clinic between 1-30 September 2021. The Hospital Anxiety and Depression Scale (HADS) and the scale examining the perspectives on Covid-19 were applied to the patients whose consent was obtained. Results: A total of 235 people, 139 women and 63 men, participated in the survey. In the review of 202 completed surveys, the median age was 55 (23-83 years). In the study in which seventeen different solid cancer patients were evaluated, breast (52.5%), colon (19.3%) and lung (10.8%) cancers were most common. Most of the people who were more afraid of Covid-19 compared to cancer were patients who were on active cancer treatment. In the multivariate regression analysis, being on active treatment was found to be the only risk factor for 'being more afraid of Covid-19' compared to cancer. During Covid-19 pandemic, it was observed that 18 (8.9%) patients delayed their treatment/follow-up due to fear of Covid-19 infection. A high HADS anxiety score was observed in 58 (28.7%) patients, and a high HADS depression score was observed in 39 patients (19.3%). Conclusion: Cancer patients are seriously worried about the progression of their cancer due to changes in follow-up or treatment due to Covid-19 pandemic. However, despite the associated risks, they were found to want to continue their treatment as planned.

Background: The COVID-19 pandemic has caused mental health problems worldwide. The psychopathological implications of COVID-19 in cancer patients have rarely been addressed. Considering the increased vulnerability of oncology patients, this issue needs to be addressed to improve the long-term mental health status of these patients.Methods: We conducted a prospective study in outpatients under active cancer treatment during the first wave of the COVID-19 pandemic. A semi-structured 24-question survey was designed to measure baseline sociodemographic, psychosocial and COVID-19 exposure characteristics. The Hospital Anxiety and Depression Scale was used to measure psychological symptoms. A descriptive and analytical univariate analysis of the variables studied was performed. We used the Z-score to compare different populations (experimental and historical control cohort).Results: 104 patients were included, the majority of which were women (64.4%), were above 65 years of age (57.7%), had either lung and breast cancer (56.7%), had advanced disease (64%) and were undergoing chemotherapy (63.5%). 51% of them expressed greater fear of cancer than of COVID-19 infection or both.In relation to HADS, 52.8% of emotional distress, 42.3% of anxiety and 58.6% of depression rates were detected. The main factors related with higher rates of psychological symptomatology were history of previous psychotropic drug consumption and the adoption of additional infection prevention measures because they considered themselves at risk of severe COVID-19 infection (p = 0.008; p = 0.003 for emotional distress, p = 0.026; p = 0.004 for anxiety, and p = 0.013; p = 0.008 for depression). Tumor type, stage, oncologic treatment or rescheduling of cancer treatments were not related to higher levels of psychological symptomatology.Comparison of our results with another population of similar characteristics was not significant (Z score = −1.88; p = 0.060).Conclusions: We detected high rates of emotional distress during the first wave of the COVID-19 pandemic among cancer patients in active treatment (52.8%). This was higher and clinically relevant than observed in a comparable population (42.5%), although not significant. Cancer itself is the main factor of concern for cancer patients, above and beyond the emotional distress generated by COVID-19 pandemic.

PurposePandemics can be associated with anxiety and depression in cancer patients who are undergoing treatment. In the present study, we aimed to perform a comparative evaluation of the conditions of cancer patients before and during the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) pandemic using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) to detect the impact of the pandemic on treatment delays that are associated with anxiety and depression in cancer patients. In addition, the effect of public transport use on treatment delays was examined.MethodsBDI and BAI were administered to 595 breast, ovarian, colon and gastric cancer patients before and during the pandemic. The questionnaires were administered by the physician blindly, who was unaware of the delay of the patients. The number of days by which the patients delayed their treatment due to the fear of contamination were recorded retrospectively. Correlation analyses were performed between the obtained scores and treatment delays.ResultsThe depression and anxiety levels in cancer patients were found to increase during the pandemic (p = 0.000), and this increase was positively correlated with the disruption of their treatment (p = 0.000, r = 0.81). Depression and anxiety levels and treatment delays were higher in elderly patients (p = 0.021). Depression and anxiety were more pronounced in female patients (p = 0.000). Moreover, treatment delays were more common in patients who had to use public transportation (p = 0.038).ConclusionSARS-CoV-2 pandemic may increase anxiety and depression in cancer patients. This can cause patients to experience treatment delays due to concerns about becoming infected. At this point, if necessary, assistance should be obtained from psychiatric and public health experts.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11136-021-02795-4.

Lung Cancer in Sudan

1573P Anxiety and depression in cancer patients during the COVID-19 pandemic: A single-centre study

The transition off active treatment is a time of significant stress for pediatric cancer patients and families. Providing information and support at this time is among the new psychosocial standards of care in pediatric oncology. This study sought to explore patient and family needs and concerns at the end of their active cancer treatment. Forty-nine caregiver-child dyads completed semi-structured interviews and surveys 1-2 months before ending treatment, and again 3-7 months after treatment concluded. Patients and caregivers reported a moderate level of understanding of follow-up care needs, late effects, and perceived preparation. Altogether, child, adolescent, and young adult cancer patients and parents identified similar priorities for information needed during the transition off active treatment. The most essential pieces of information desired by patients and families across time points included reviews of late effects, schedules for follow-up care, health and physical restrictions, communication with the patient's primary care provider, and provision of a treatment summary. At Time 2, patients and families reported a greater retrospective desire for emotional health resources. Most patients and caregivers wanted information from a variety of sources, but the desired timing to receive this information varied and was dependent on disease group. There are many essential components to end-of-treatment care that are not consistently provided to pediatric cancer patients and families. Formalized programs offering education and support should be provided by multidisciplinary teams prior to the end of active treatment.