Quality of Life and Depression Symptoms in a Cross-Section of Patients with Advanced Lung Cancer Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic (RP322)

Abstract

Outcomes1. Evaluate the effect of the COVID-19 pandemic on quality of life (QOL) and depression symptoms among patients recently diagnosed with lung cancer2. Apply the results of these analyses to identify patients with newly diagnosed cancer at risk of worse QOL or psychological symptoms during a pandemic or other major crisis in order to allocate supportive care resourcesImportanceAdults with advanced lung cancer commonly experience reduced quality of life (QOL) and psychological symptoms at diagnosis. The COVID-19 pandemic has caused universal distress, but whether it has worsened the experience of patients recently diagnosed with cancer is unclear.Objective(s)This study evaluates associations between the COVID-19 pandemic and QOL and depression among adults with newly diagnosed advanced lung cancer.Method(s)We analyzed baseline data from two randomized controlled trials of early palliative care for patients recently diagnosed with advanced lung cancer (n = 856) to compare QOL and depression among those who enrolled during the COVID-19 pandemic (March 2020 to January 2021) relative to those enrolled prior to the pandemic (March 2018 to January 2019). We used analysis of covariance with the COVID-19 timeframe as the independent variable and QOL (using the Functional Assessment of Cancer Therapy–General score) and depression (using the Patient Health Questionnaire–9 score) as dependent variables, adjusting for age, gender, relationship status, performance status, lung cancer symptoms, and time since diagnosis. We also tested for an interaction between the COVID-19 timeframe and relationship status.IV. ResultsThere was no difference in QOL (adjusted mean difference –1.78; p = 0.137) or depression (0.06; p = 0.889) between patients enrolled before COVID-19 relative to those enrolled during COVID-19 in adjusted analyses. Relationship status moderated the effect of the COVID-19 timeframe on QOL; unmarried patients enrolled during the pandemic experienced significantly worse QOL relative to unmarried patients enrolled pre-pandemic (adjusted mean difference: –5.25; p = 0.011).V. Conclusion(s)The COVID-19 pandemic did not further reduce QOL or increase depression overall for patients recently diagnosed with lung cancer, which suggests that QOL reflects other factors, such as symptoms, that do not vary with this external crisis. Reduced QOL among unmarried patients points to increased supportive care needs.VI. ImpactThese results emphasize the profound effect of a new diagnosis of cancer on QOL and highlight the need for psychosocial evaluation and supportive care for all patients.