Stressors and the adaptation of telemedicine for women on poly(ADP-ribose) polymerase (PARP) inhibitor maintenance during the COVID-19 pandemic

Abstract

<h3>Objectives:</h3> Poly(ADP-ribose) polymerase inhibitor maintenance (PARPm) therapy is now available to all women with advanced ovarian cancer following response to initial chemotherapy. As the COVID-19 pandemic has resulted in unprecedented challenges for cancer patients, we aimed to evaluate the unique experience for women on maintenance PARP inhibitors. <h3>Methods:</h3> Women with a current or prior diagnosis of ovarian cancer completed an online survey focusing on treatment interruptions and quality of life (QOL). QOL was measured with the Cancer Worry Scale and Hospital Anxiety and Depression Scale. The survey was distributed through survivor networks and social media. The chi-square and ANOVA test were used with a Bonferroni correction to account for multiple comparison testing. <h3>Results:</h3> Six hundred and three women, from 41 states, visited the survey website between March 30 and April 13, 2020 and 525 (87%) completed the survey and provided information on current treatment status. Sixty-four women (12%) were on PARPm, 153 (29%) on other anti-cancer therapy and 308 (59%) on no treatment. Other anticancer therapies included intravenous chemotherapy (61, 40%), anti-angiogenic (29, 19%), hormonal (25, 16%), oral chemotherapy (12, 8%), immunotherapy (10, 6.5%) and other (16, 10%). There were no differences among women on PARPm, no treatment or other treatment for disease stage, medical comorbidities, COVID-19 symptoms or treatment delays. Women on PARPm were more likely to be self-described as immunocompromised versus women not on treatment (79% vs. 34%, P<0.001) and women on hormonal therapy (79% vs. 40%, P=0.002) and similar to women on oral -anti-cancer therapy (78% vs. 58%, P=0.336). Women on PARPm were more likely to use telemedicine versus women not on treatment (44% vs. 16%, P<0.001) and had similar use of telemedicine compared to all other treatment groups. For women on PARPm, higher cancer worry scores were associated with increased use of telemedicine (used telemedicine - 14.4 vs. did not use telemedicine - 13.3, P=0.007). There were no significant differences in reported cancer worry, anxiety or depression between women on PARPm, other anti-cancer therapy and no treatment. <h3>Conclusions:</h3> The COVID-19 crisis is impacting cancer care and it is critical that providers consider and address the unique stressors facing women with ovarian cancer during this challenging time. Women on PARPm, in particular, perceive themselves as immunocompromised, perhaps making them more open to alternative means of care delivery, as demonstrated by their willingness to adopt telemedicine. Women with ovarian cancer on PARPm report similar cancer worry, anxiety and depression to women not on treatment and those on other anti-cancer treatment.