Abstract
In response to the ongoing coronavirus disease 2019 (COVID-19) pandemic, governments imposed various measures to decrease the rate of disease spread, and health care policy makers prioritized resource allocation to accommodate COVID-19 patients. We conducted a cross-sectional online survey in Germany (July 2020–June 2021) to assess the frequency of changes to cancer care among cancer patients and to explore the psychological impact of the pandemic writ large. Cancer patients who contacted the Cancer Information Service (Krebsinformationsdienst, KID) of the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) via email were invited to complete an online questionnaire, capturing demographics, cancer specifics (e.g., type, disease phase, primary place of treatment, etc.), and any changes to their medical, follow-up, psycho-oncological or nursing care. General level of psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS) along with face-validated items regarding worries and social isolation specific to the pandemic. In total, 13% of 621 patients reported a change to their treatment or care plan. Of those patients with changes, the majority of changes were made to follow-up care after treatment (56%), to monitoring during treatment (29%) and to psychological counseling (20%). Of the overall sample, more than half of patients (55%) reported symptoms of anxiety and 39% reported symptoms of depression. Patients with a change in cancer care were more likely to report symptoms of depression than those with no change (AOR: 2.18; 95% CI: 1.26–3.76). Concern about the pandemic affecting the quality of health care was a predictor of both anxiety (AOR: 2.76; 95% CI: 1.75–4.35) and depression (AOR: 2.15; 95% CI: 1.43–3.23). Results showed that the majority of cancer patients in our study did not experience a change in their cancer care. However, the level of anxiety and psycho-social burden of cancer patients during the pandemic was high throughout the study period. Our findings underscore the need for health care services and policy makers to assess and to attend cancer patients' medical needs, with added emphasis on patients' psychological and social well-being. This applies particularly in situations where the healthcare system is strained and prioritization is necessary.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on health care
Our results indicate that the majority of cancer patients contacting the Cancer Information Service during the COVID19 pandemic did not experience a change in primary cancer treatment
The level of anxiety and psycho-social burden of cancer patients during the pandemic remained high, for those patients who experienced a change in their care
Summary
The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on health care. The pandemic reached Germany in January 2020 and within 100 days, the number of confirmed cases exceeded 150,000, with over 6,200 deaths [1]. By late March, 2020, business closures were mandated, school classes were relegated to being conducted online, and gatherings of people were greatly restricted. Some of these restrictions were eased by late April; a second wave (i.e., a substantial increase in COVID-19 infections) in the fall of 2020 and a third wave in the spring of 2021 kept varying restrictions in place on businesses, schools and social gatherings. By September 23, 2021, over four million cases and more than 93,000 deaths had been confirmed in the country [2]
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