COVID-19 Amplifies Stress, Loneliness in Cancer Survivors

The coronavirus disease 2019 (COVID-19) pandemic has increased symptom burden – including anxiety and depression rates – in patients with cancer, according to ongoing research presented at the National Institute of Nursing Research’s Symptom Science Advances in Oncology Nursing virtual event.

“Oncology patients, during COVID-19, are experiencing a very high symptom burden,” study author Christine Miaskowski, PhD, RN, FAAN, Sharon A. Lamb Endowed Chair in Physiological Nursing and professor in the department of physiological nursing at the UCSF Helen Diller Family Comprehensive Cancer Center, said during her presentation.

More than 600 cancer survivors completed an online survey about symptom burden, which were compared to statistics from patients before the COVID-19 pandemic and the general population. The majority were female; 40% were on active treatment; about 25% lived alone; and a third had metastatic disease.

“The general population is experiencing a high amount of stress during the COVID-19 pandemic,” Miaskowski said. “So in some ways, we’re adding insult to injury. There’s a large [body] of literature on the fact that a cancer diagnosis itself and treatment is stressful for patients. And now we add these stressors in the context of COVID-19.”

Before COVID-19, about 15% to 30% of cancer survivors reported high depression scores (indicated by a score of 16% or higher per the Center for Epidemiological Studies scale). This number increased to 40.7% during the pandemic, which was also higher than the general population, which had a 33.7% rate of depression.

Trait- and state-related anxiety rates also increased in cancer survivors during the COVID-19 pandemic, increasing from 30% and 50%, respectively, prior to the pandemic, increasing to 58.3% and 48.4% after. In the general population, there was a 31.9% rate of anxiety during the COVID-19 pandemic.

When it came to sleep disturbances, more than twice the amount of patients with cancer experienced the symptom (61.4%) compared to those without a cancer history (18%-30%) during the COVID-19 pandemic.

Additionally, many patients reported feelings of loneliness as a result of social isolation. Considering that the bulk of the participants in the study were White, educated, and finished with active treatment, Miaskowski noted her concerns for those in more vulnerable populations and what they may be going through.

“I have a long list of questions about what’s happening to other groups of individuals who are less fortunate,” she said.

Moving forward, Miaskowski encouraged oncology nurses to talk to their patients about symptom burden and loneliness – during the pandemic and beyond.

“I’m going to pressure the clinicians in the room that we need to assess for stress and types of stressors. I think in some cases, it might just be enough to acknowledge that the patient is experiencing stress,” she said. “I know these conversations take time, but I think in the era of COVID-19, the vaccine administration, and post-COVID-19, we need to think about who can have these conversations and when.”