Changes in experienced quality of oncological cancer care during the COVID-19 pandemic based on patient reported outcomes – a cross-sectional study
DOI:
https://doi.org/10.2340/1651-226X.2024.40141Keywords:
COVID-19, patient reported outcome, questionaires, CancerAbstract
Aim: The study aims to investigate the impact of the COVID-19 pandemic on cancer patients’ perceptions of the quality of their oncological treatment and care.
Background: The COVID-19 pandemic disrupted healthcare delivery and oncological resources were repurposed, potentially leading to prolonged treatment and reduced access to innovative therapies and clinical trials. Still, little is known about how patients perceived the quality of their treatment.
Methods: A cross-sectional study was conducted in the spring of 2020 among cancer patients at the Department of Oncology, Aarhus University Hospital and Rigshospitalet, Denmark. Patients were invited to complete an online questionnaire on clinical, socioeconomic, emotional, behavioural, and quality-related aspects of oncological cancer care. Patients who experienced reduced treatment quality and those who reported no or slight reductions were compared using multiple logistic regression, exploring the associations with patient characteristics, behaviours, and fear of cancer progression or recurrence.
Results: A total of 2,040/5,372 patients experienced changes in their treatment plans during the pandemic, and 1,570/5,372 patients experienced reduced treatment quality, with 236 reporting a high degree of reduction. Patients with breast, head and neck, and upper gastrointestinal cancers were more likely to experience reduced treatment quality. Altered interactions with healthcare providers, along with isolation, lack of social support, and heightened fear of cancer progression, were significant risk factors for experiencing reduced cancer care quality.
Interpretation: We identified subgroups of cancer patients needing targeted communication and care during health crises affecting cancer treatment. The findings underscore the importance of safeguarding the needs of vulnerable patient populations in future healthcare emergencies.
Downloads
References
Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335–7. DOI: https://doi.org/10.1016/S1470-2045(20)30096-6
https://doi.org/10.1016/S1470-2045(20)30096-6 DOI: https://doi.org/10.1016/S1470-2045(20)30096-6
Akladios C, Azais H, Ballester M, et al. Recommendations for the surgical management of gynecological cancers during the COVID-19 pan-demic – FRANCOGYN group for the CNGOF. J Gynecol Obstet Hum Reprod. 2020;49(6):101729. DOI: https://doi.org/10.1016/j.jogoh.2020.101729
https://doi.org/10.1016/j.jogoh.2020.101729 DOI: https://doi.org/10.1016/j.jogoh.2020.101729
Ansarin M. Surgical management of head and neck tumours during the SARS-CoV (COVID-19) pandemic. Acta Otorhinolaryngol Ital. 2020;40(2):87–9. DOI: https://doi.org/10.14639/0392-100X-N0783
https://doi.org/10.14639/0392-100X-N0783 DOI: https://doi.org/10.14639/0392-100X-N0783
Bartlett DL, Howe JR, Chang G, et al. Management of cancer surgery cases during the COVID-19 pandemic: considerations. Ann Surg Oncol. 2020;27(6):1717–20. DOI: https://doi.org/10.1245/s10434-020-08461-2
https://doi.org/10.1245/s10434-020-08461-2 DOI: https://doi.org/10.1245/s10434-020-08461-2
Burki TK. Cancer guidelines during the COVID-19 pandemic. Lancet Oncol. 2020;21(5):629–30. DOI: https://doi.org/10.1016/S1470-2045(20)30217-5
https://doi.org/10.1016/S1470-2045(20)30217-5 DOI: https://doi.org/10.1016/S1470-2045(20)30217-5
Catanese S, Pentheroudakis G, Douillard JY, et al. ESMO management and treatment adapted recommendations in the COVID-19 era: pancreatic cancer. ESMO Open. 2020;5(Suppl 3):e000804. DOI: https://doi.org/10.1136/esmoopen-2020-000804
https://doi.org/10.1136/esmoopen-2020-000804 DOI: https://doi.org/10.1136/esmoopen-2020-000804
de Azambuja E, Trapani D, Loibl S, et al. ESMO management and treatment adapted recommendations in the COVID-19 era: breast cancer. ESMO Open. 2020;5(Suppl 3):e000793. DOI: https://doi.org/10.1136/esmoopen-2020-000793
https://doi.org/10.1136/esmoopen-2020-000793 DOI: https://doi.org/10.1136/esmoopen-2020-000793
Di Fiore F, Bouché O, Lepage C, et al. COVID-19 epidemic: proposed alternatives in the management of digestive cancers: a French inter-group clinical point of view (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR). Dig Liver Dis. 2020;52(6):597–603. DOI: https://doi.org/10.1016/j.dld.2020.03.031
https://doi.org/10.1016/j.dld.2020.03.031 DOI: https://doi.org/10.1016/j.dld.2020.03.031
Perrone AM, De Palma A, De Iaco P. COVID-19 global pandemic: options for management of gynecologic cancers. The experience in surgical management of ovarian cancer in the second highest affected Italian region. Int J Gynecol Cancer. 2020;30(6):902. DOI: https://doi.org/10.1136/ijgc-2020-001489
https://doi.org/10.1136/ijgc-2020-001489 DOI: https://doi.org/10.1136/ijgc-2020-001489
The Lancet Oncology. COVID-19: global consequences for oncology. Lancet Oncol. 2020;21(4):467. DOI: https://doi.org/10.1016/S1470-2045(20)30175-3
https://doi.org/10.1016/S1470-2045(20)30175-3 DOI: https://doi.org/10.1016/S1470-2045(20)30175-3
Vecchione L, Stintzing S, Pentheroudakis G, et al. ESMO management and treatment adapted recommendations in the COVID-19 era: colorectal cancer. ESMO Open. 2020;5(Suppl 3):e000826. DOI: https://doi.org/10.1136/esmoopen-2020-000826
https://doi.org/10.1136/esmoopen-2020-000826 DOI: https://doi.org/10.1136/esmoopen-2020-000826
Chew QH, Wei KC, Vasoo S, et al. Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: practical considerations for the COVID-19 pandemic. Singapore Med J. 2020;61(7):350–6. DOI: https://doi.org/10.11622/smedj.2020046
https://doi.org/10.11622/smedj.2020046 DOI: https://doi.org/10.11622/smedj.2020046
Horesh D, Brown AD. Traumatic stress in the age of COVID-19: a call to close critical gaps and adapt to new realities. Psychol Trauma. 2020;12(4):331–5. DOI: https://doi.org/10.1037/tra0000592
https://doi.org/10.1037/tra0000592 DOI: https://doi.org/10.1037/tra0000592
Zhang L, Liu X, Tong F, et al. The prevalence of psychological disorders among cancer patients during the COVID-19 pandemic: a meta-analysis. Psychooncology. 2022;31(11):1972–87. DOI: https://doi.org/10.1002/pon.6012
https://doi.org/10.1002/pon.6012 DOI: https://doi.org/10.1002/pon.6012
Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81. DOI: https://doi.org/10.1016/j.jbi.2008.08.010
https://doi.org/10.1016/j.jbi.2008.08.010 DOI: https://doi.org/10.1016/j.jbi.2008.08.010
Lee JJ, Choi HR, Choi EP, et al. Psychometric evaluation of Korean version of COVID-19 fear scale (K-FS-8): a population based cross-sectional study. PLoS One. 2023;18(3):e0282589. DOI: https://doi.org/10.1371/journal.pone.0282589
https://doi.org/10.1371/journal.pone.0282589 DOI: https://doi.org/10.1371/journal.pone.0282589
Thewes B, Zachariae R, Christensen S, et al. The concerns about recurrence questionnaire: validation of a brief measure of fear of cancer recurrence amongst Danish and Australian breast cancer survivors. J Cancer Surviv. 2015;9(1):68–79. DOI: https://doi.org/10.1007/s11764-014-0383-1
https://doi.org/10.1007/s11764-014-0383-1 DOI: https://doi.org/10.1007/s11764-014-0383-1
Aggerholm-Pedersen N, Jespersen TW, Olsen PR, et al. Pain audit as a tool to optimize pain treatment in hospital departments. Ugeskr Laeger. 2013;175(21):1491–5.
Cook KF, Jensen SE, Schalet BD, et al. PROMIS measures of pain, fatigue, negative affect, physical function, and social function demonstrated clinical validity across a range of chronic conditions. J Clin Epidemiol. 2016;73:89–102. DOI: https://doi.org/10.1016/j.jclinepi.2015.08.038
https://doi.org/10.1016/j.jclinepi.2015.08.038 DOI: https://doi.org/10.1016/j.jclinepi.2015.08.038
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96. DOI: https://doi.org/10.2307/2136404
https://doi.org/10.2307/2136404 DOI: https://doi.org/10.2307/2136404
Ahorsu DK, Lin CY, Imani V, et al. The fear of COVID-19 scale: development and initial validation. Int J Ment Health Addict. 2022;20(3):1537–45. DOI: https://doi.org/10.1007/s11469-020-00270-8
https://doi.org/10.1007/s11469-020-00270-8 DOI: https://doi.org/10.1007/s11469-020-00270-8
Lang JJ, Narendrula A, Iyer S, et al. Patient-reported disruptions to cancer care during the COVID-19 pandemic: a national cross-sectional study. Cancer Med. 2023;12(4):4773–85. DOI: https://doi.org/10.1002/cam4.5270
https://doi.org/10.1002/cam4.5270 DOI: https://doi.org/10.1002/cam4.5270
Dalby M, Ailawadi N. The experience of cancer patients during the COVID-19 pandemic. J Oncol Pharm Pract. 2023;29(2):283–9. DOI: https://doi.org/10.1177/10781552211066891
https://doi.org/10.1177/10781552211066891 DOI: https://doi.org/10.1177/10781552211066891
de Joode K, Dumoulin DW, Engelen V, et al. Impact of the coronavirus disease 2019 pandemic on cancer treatment: the patients’ perspec-tive. Eur J Cancer. 2020;136:132–9. DOI: https://doi.org/10.1016/j.ejca.2020.06.019
https://doi.org/10.1016/j.ejca.2020.06.019 DOI: https://doi.org/10.1016/j.ejca.2020.06.019
Spencer K, Jones CM, Girdler R, et al. The impact of the COVID-19 pandemic on radiotherapy services in England, UK: a population-based study. Lancet Oncol. 2021;22(3):309–20. DOI: https://doi.org/10.1016/S1470-2045(20)30743-9
https://doi.org/10.1016/S1470-2045(20)30743-9 DOI: https://doi.org/10.1016/S1470-2045(20)30743-9
Micek A, Diehl K, Teuscher M, et al. Melanoma care during one year pandemic in Berlin: decreasing appointment cancellations despite increasing COVID-19 concern. J Dtsch Dermatol Ges. 2022;20(7): 962–78. DOI: https://doi.org/10.1111/ddg.14799
https://doi.org/10.1111/ddg.14799 DOI: https://doi.org/10.1111/ddg.14799
Veeraiah S, Chidambaram S, Sudhakar R, et al. Psychosocial issues and concerns of cancer patients due to COVID-19 pandemic lockdown. PLOS Glob Public Health. 2022;2(9):e0000996. DOI: https://doi.org/10.1371/journal.pgph.0000996
https://doi.org/10.1371/journal.pgph.0000996 DOI: https://doi.org/10.1371/journal.pgph.0000996
Ripamonti CI, Massa G, Insolvibile D, et al. Fears, beliefs, and quality of life of patients with cancer vs the general population during the coronavirus disease 2019 (COVID-19) pandemic in Lombardy. Tumori. 2022;108(5):431–8. DOI: https://doi.org/10.1177/03008916211022848
https://doi.org/10.1177/03008916211022848 DOI: https://doi.org/10.1177/03008916211022848
Hossain MM, Sultana A, Purohit N. Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence. Epidemiol Health. 2020;42:e2020038. DOI: https://doi.org/10.4178/epih.e2020038
https://doi.org/10.4178/epih.e2020038 DOI: https://doi.org/10.4178/epih.e2020038
Bäuerle A, Teufel M, Musche V, et al. Increased generalized anxiety, depression and distress during the COVID-19 pandemic: a cross-sectional study in Germany. J Public Health (Oxf). 2020;42(4):672–8. DOI: https://doi.org/10.1093/pubmed/fdaa106
https://doi.org/10.1093/pubmed/fdaa106 DOI: https://doi.org/10.1093/pubmed/fdaa106
Lu J, Wang F, Wang X, et al. Inequalities in the health survey using validation question to filter insufficient effort responding: reducing overestimated effects or creating selection bias? Int J Equity Health. 2019;18(1):131. DOI: https://doi.org/10.1186/s12939-019-1030-2
https://doi.org/10.1186/s12939-019-1030-2 DOI: https://doi.org/10.1186/s12939-019-1030-2
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2023 Ninna Aggerholm-Pedersen, Lise Bech Jellesmark Thorsen, Nina Møller Tauber, Josefine Tingdal Danielsen, Katrine Løppenthin, Signe Borgquist, Christoffer Johansen, Robert Zacharie
This work is licensed under a Creative Commons Attribution 4.0 International License.
