Cancer survivors' cancellations of healthcare appointments during the COVID-19 pandemic: Associations with anxiety and depression.

Abstract

Though it is well-documented that cancer survivors experienced healthcare delays during the COVID-19 pandemic, who initiated those delays has not been examined. This longitudinal study distinguishes rates of patient-from provider-cancelled healthcare appointments at three timepoints during the pandemic, and examines psychosocial factors associated with patient-cancelled appointments. Cancer survivors (N=147) in the United States completed psychosocial and health behavior measures three times between May and December 2020. We examined rates of patient- and provider-cancelled healthcare appointments, including cancer screening appointments, at each timepoint and change between timepoints. Logistic regression was used to determine if anxiety symptoms, depression symptoms, and COVID-19 fears were associated with self-cancelled healthcare appointments. In May 2020, one third (33.79%) of participants reported one or more self-cancelled appointments within the prior 2months and nearly half (45.89%) reported one or more provider-cancelled appointments. Rates of provider-cancelled appointments decreased to 35.71% in June/July 2020 and to 9.24% in November/December 2020 (both reflected p<0.05 reductions compared to the previous timepoint). Rates of self-cancelled appointments, however, remained more stable (ps>0.144). In June/July and November/December 2020, higher depression and anxiety symptoms, but not COVID-19 fears, were associated with greater likelihood of self-cancelled appointments. Cancer survivors cancelled their healthcare appointments at a stable rate even as provider-cancelled appointments declined. Depression and anxiety symptoms, but not COVID-19 concerns, were associated with patient cancellations. Interventions that address anxiety and depression symptoms may help to promote adherence to cancer survivorship care during the pandemic.