Abstract
ObjectiveThe outbreak of COVID-19 pandemic has greatly impacted on radiotherapy (RT) strategy for breast cancer patients, which might lead to increased distressing psychological symptoms. We performed a multi-center cross-section survey to investigate prevalence of fear of cancer recurrence (FCR) and predictors for FCR in patients referred to RT during pandemic.Methods542 patients were consecutively enrolled from three regions in China including Yangtze Delta River Region, Guangdong and Shanxi province. Patients’ characteristics were collected using an information sheet, Fear of progression questionnaire-short form, Hospital Anxiety/Depression Scale and EORTC QLQ-C30. The hierarchical multiple regression models were performed.Results488 patients with complete data were eligible. The RT strategy was affected in 265 (54.3%) patients, including 143 with delayed RT initiation, 66 believing to have delayed RT initiation but actually not, 24 with RT interruptions, 19 shifting to local hospitals for RT and the remaining 13 influenced on both RT schedule and hospital level. The model explained 59.7% of observed variances in FCR (p<0.001) and showed that influence of RT strategy had significantly impacted on FCR (△R2 = 0.01, △F=2.966, p=0.019). Hospitals in Shanxi province (β=-0.117, p=0.001), emotional function (β=-0.19, p<0.001), social function (β=-0.111, p=0.006), anxiety (β=0.434, p<0.001) and RT interruption (β=0.071, p=0.035) were independent predictors.ConclusionsRT strategy for breast cancer patients was greatly influenced during pandemic. RT interruption is an independent predictor for high FCR. Our findings emphasize the necessity to ensure continuum of RT, and efforts should be taken to alleviate FCR through psychological interventions.
Highlights
From late December in 2019, severe outbreak of the novel coronavirus disease (COVID-19) pandemic in China has greatly impacted the routine medical practice for cancer patients, which has brought great psychological pressure on patients, especially for those who undergo anti-cancer treatments
For the Yangtze River Delta Region, 89 (46.6%) and 93 (48.7%) patients were from Shanghai and Jiangsu Province respectively, only 9 (4.7%) patients came from Zhejiang where the number of newly confirmed COVID-19 patients was high (Figure 1A)
The final model indicated that hospitals located in Shanxi province (b=-0.117, p=0.001), emotional function (b=-0.19, p
Summary
From late December in 2019, severe outbreak of the novel coronavirus disease (COVID-19) pandemic in China has greatly impacted the routine medical practice for cancer patients, which has brought great psychological pressure on patients, especially for those who undergo anti-cancer treatments. Cancer patients are generally at systemic immunosuppressive status (whether caused by the disease or anti-cancer therapies), are more susceptible to COVID19 infection and more likely to have morbidity than the general population [1,2,3]. Recently published studies mostly focused on psychological symptoms caused by COVID-19 among the medical staffs and general population [7,8,9], limited data regarding psychological status of cancer patients during pandemic is available, especially for patients with affected anticancer treatment due to COVID-19. During the peak of pandemic, a series of Abbreviations: COVID-19, Novel coronavirus disease; BC, Breast cancer; RT, Radiotherapy; CT, Computed tomography; FCR, Fears of cancer recurrence; CSCO BC, Chinese Society of Clinical Oncology Breast Cancer; FoP-Q-SF, Fear of Progression Questionnaire ⁃Short Form; HADS, Hospital Anxiety and Depression Scale; QoL, quality of life; NAC, neoadjuvant chemotherapy; ANOVA, one-way analysis of variance; SD, standard distance; PST, problem solving therapy
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