Abstract
Cancer causes substantial emotional and psychosocial distress, which may be exacerbated by delays in treatment. The COVID-19 pandemic has resulted in increased wait times for many patients with cancer. In this study, the psychosocial distress associated with waiting for cancer surgery during the pandemic was investigated. This cross-sectional, convergent mixed-methods study included patients with lower priority disease during the first wave of COVID-19 at an academic, tertiary care hospital in eastern Canada. Participants underwent semi-structured interviews and completed two questionnaires: Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS). Qualitative analysis was completed through a thematic analysis approach, with integration achieved through triangulation. Fourteen participants were recruited, with cancer sites including thyroid, kidney, breast, prostate, and a gynecological disorder. Increased anxiety symptoms were found in 36% of patients and depressive symptoms in 14%. Similarly, 64% of patients experienced moderate or high stress. Six key themes were identified, including uncertainty, life changes, coping strategies, communication, experience, and health services. Participants discussed substantial distress associated with lifestyle changes and uncertain treatment timelines. Participants identified quality communication with their healthcare team and individualized coping strategies as being partially protective against such symptoms. Delays in surgery for patients with cancer during the COVID-19 pandemic resulted in extensive psychosocial distress. Patients may be able to mitigate these symptoms partially through various coping mechanisms and improved communication with their healthcare teams.
Highlights
Cancer causes emotional and psychosocial distress as patients face disease and treatment-related mortality and morbidity, as well as grief over personal and healthrelated losses, and a sense of helplessness [1]
We examined patients in the lowest priority band who faced delays in management
Gagliardi and colleagues explored the available literature on the psychosocial impact of waiting for surgery and highlighted the need for studies examining the additional distress experienced by patients awaiting surgery during the COVID-19 pandemic [22]
Summary
Cancer causes emotional and psychosocial distress as patients face disease and treatment-related mortality and morbidity, as well as grief over personal and healthrelated losses, and a sense of helplessness [1]. With the COVID-19 pandemic, patients may experience further distress, owing to decreased perioperative resources and resultant fear of treatment availability. Cancer patients with less aggressive diagnoses are facing substantial treatment delays. The psychosocial distress experienced by patients who experience these delays is unknown in the literature and is hypothesized to be substantial. Exacerbating this situation is the fact that many protective factors against patient distress are impacted by physical-distancing measures, such as diminished family support and decreased physical well-being. A more comprehensive evaluation of COVID-19 resource rationing in cancer surgery, including psychosocial outcomes, represents an important knowledge gap to consider, especially with the uncertainty of the pandemic time frame. This study sought to examine the psychosocial outcomes of patients awaiting cancer surgery during the COVID-19 pandemic
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