Stress and Symptom Burden in Oncology Patients During the COVID-19 Pandemic

Christine Miaskowski, Steven M Paul, Karin Snowberg, Maura Abbott, Hala Borno, Susan Chang, Lee M Chen, Bevin Cohen, Marilyn J Hammer, Stacey A Kenfield, Kord M Kober, Jon D Levine, Rachel Pozzar, Kim F Rhoads, Erin L Van Blarigan, Katherine Van Loon, Christine Miaskowski, Steven M Paul, Karin Snowberg, Maura Abbott, Hala Borno, Susan Chang, Lee M Chen, Bevin Cohen, Marilyn J Hammer, Stacey A Kenfield, Kord M Kober, Jon D Levine, Rachel Pozzar, Kim F Rhoads, Erin L Van Blarigan, Katherine Van Loon

Abstract

Context: No information is available on oncology patients' level of stress and symptom burden during the coronavirus disease 2019 (COVID-19) pandemic.

Objectives: To evaluate for differences in demographic and clinical characteristics, levels of social isolation and loneliness, and the occurrence and severity of common symptoms between oncology patients with low vs. high levels of COVID-19 and cancer-related stress. In addition, to determine which of these characteristics were associated with membership in the high-stressed group.

Methods: Patients were 18 years and older; had a diagnosis of cancer; and were able to complete an online survey.

Results: Of the 187 patients in this study, 31.6% were categorized in the stressed group (Impact of Event Scale-Revised [score of ≥24]). Stressed group's Impact of Event Scale-Revised score exceeds previous benchmarks in oncology patients and equates with probable post-traumatic stress disorder. In this stressed group, patients reported occurrence rates for depression (71.2%), anxiety (78.0%), sleep disturbance (78.0%), evening fatigue (55.9%), cognitive impairment (91.5%), and pain (75.9%). Symptom severity scores equate with clinically meaningful levels for each symptom.

Conclusion: We identified alarmingly high rates of stress and an extraordinarily high symptom burden among patients with cancer, exceeding those previously benchmarked in this population and on par with noncancer patients with post-traumatic stress disorder. Given that the COVID-19 pandemic will likely impact cancer care for an indefinite period, clinicians must exhibit increased vigilance in their assessments of patients' level of stress and symptom burden. Moreover, an increase in referrals to appropriate supportive care resources must be prioritized for high-risk patients.

Keywords: COVID-19; Symptoms; cancer; loneliness; social isolation; stress.

Copyright © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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