COVID-19 pandemic caused more anxiety, treatment delays for people with lung cancer
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Patients with lung cancer reported high levels of anxiety and often experienced treatment delays during the COVID-19 pandemic, according to a single-center study conducted in Mexico.
The findings showed depression among patients with thoracic neoplasms is linked to treatment delays, and that changes in primary treatment — particularly pandemic-caused delays — are associated with shorter survival, Oscar Arrieta, MD, of Instituto Nactional de Cancerologia in Mexico City, reported during International Association for the Study of Lung Cancer’s World Conference on Lung Cancer.
“Mental health is paramount in order to move forward with oncologic care,” Arrieta told Healio. “It is essential to evaluate and constantly assess our patients mental health status and intervene when necessary with options for treatment.”
Evidence suggests patients with lung cancer have been particularly vulnerable through the pandemic, according to study background.
Arrieta and colleagues aimed to assess the prevalence and impact of COVID-19 pandemic-caused psychological disorders among people with lung cancer.
“From early on in the pandemic, we started to identify patients were reluctant to attend their medical appointments,” Arrieta said. “In Mexico City, and particularly in the hospital where we are based, patients are mostly resource-limited and, therefore, must take several [forms of] public transportation (subway, buses, etc.) in order to get to their scheduled appointments.
“Many were extremely anxious about the possibility of [COVID-19 infection],” Arrieta added. “We thought it would be important to study the impact of this on our population.”
Arrieta and colleagues performed a cross-sectional mental health evaluation at their center between March 1, 2020, and Feb. 28 of this year.
The analysis included 548 patients (mean age, 61.5 years), most of whom had non-small cell lung cancer (86.9%) and metastatic disease (80%). A majority (82.8%) were on active treatment.
Investigators used the Depression Anxiety and Stress Scale 21 (DASS-21) — a 21-question survey split into three sections — to assess anxiety, depression and distress.
Results showed a mean DASS-21 score of 10.45, with women reporting higher mean scores than men (11.41 vs. 9.08; P < .001).
Nearly one-third (30.5%) of patients indicated they experienced anxiety during the pandemic; 18% of patients reported depression and 18% reported feeling distress.
Approximately one-quarter (23.9%) of patients experienced changes in their treatment, and the majority (78.6%) indicated the changes were due to the COVID-19 pandemic.
The most frequent treatment modifications included delays of 7 days or longer (41.9%) and treatment suspension (37.4%).
After researchers adjusted for sex and age, results showed patients who reported depression were more than four times as likely as those without depression to experience treatment delays (OR = 4.5; 95% CI, 1.53-13.23). Those with stress also were more likely to experience delays (OR = 3.18; 95% CI, 1.2-10.06). Anxiety did not appear associated with treatment delays.
Patients who experienced no changes to treatment achieved significantly longer PFS (HR = 0.21; P < .001) and OS (HR = 0.28; P < .001).
The results indicate psychological disorders could have a role in treatment adherence, researchers said.
“I was particularly surprised by the fact that ... patients did not want to attend the clinic ... for treatments — which, in many cases, are provided at very low cost or free of charge,” Arrieta said. “The feeling of hopelessness from ... the neoplastic disease added to the fear from infection was so deep-seeded that it prevented patients from receiving treatment. Clearly, this would have profound implications for their outcomes and mental health.”
The findings highlight an important consideration that could improve treatment in the post-pandemic era, according to the researchers.
“All thoracic oncology clinics must consider the necessity of having a team that includes psychologists and psychiatrists in order to assess mental health and improve overall care,” Arrieta told Healio.
Perspective
Back to TopShani Shilo, DMD, PhD
COVID-19 affected all of us. Many people experienced anxiety and depression, so imagine what the pandemic has been like for people who have a disease like lung cancer. In the beginning, they didn't know if they should go see their physician or stay home and skip treatment.
This study shows depression and anxiety in this patient population led to treatment suspension, and treatment suspension led to death.
This highlights that patients' mental health is of great importance, even beyond the pandemic, and sometimes we do not address it seriously enough.
When the medical team gets together to talk about a case, they call it a tumor board. However, we are not treating a tumor. We are treating a human being. We should be addressing all aspects of the patient, including mental health. We also need to think about the patient's family and their caregiver and see how we can help them, too.
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Arrieta O, et al. Abstract OA17.03. Presented at: International Association for the Study of Lung Cancer World Conference on Lung Cancer (virtual meeting); Sept. 8-14, 2021.
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