medwireNews: Women with breast cancer had higher than normal levels of severe anxiety, depression, distress, and insomnia at the peak of the COVID-19 outbreak in the Hubei Province in China, study findings indicate.
The analysis of patient-reported outcomes (PROs), conducted among 658 women in February 2020, also found that that poor psychological status was independently associated with poor general condition, short duration after breast cancer diagnosis, having aggressive molecular subtypes or metastatic disease, treatment discontinuation, central venous catheter (CVC) flushing delay, and close contact with COVID-19 patients.
Among the women included in the study by Chen Chuang (Renmin Hospital of Wuhan University, China) and colleagues, the majority reported good or average physical condition (75.4%), had early-stage breast cancer (59.6%), and reported a history of prior breast surgery (95.4%).
Breast cancer treatment was recommended in 474 (72.0%) patients, but 46.2% of these had to discontinue or modify their planned treatment regimen during the outbreak. In addition, 40.6% of 276 patients with a CVC had to delay flushing for over 4 weeks.
The researchers report that the main concerns among the study participants were the efficacy of a compromised anticancer therapeutic regimen (53.7%) and fear of contracting COVID-19 (19.8%).
All patients completed four online questionnaires to assess their levels of psychological distress; 8.9% reported severe anxiety on the Generalized Anxiety Disorder Questionnaire-7; 9.3% reported severe depression on the Patient Health Questionnaire-9; 20.8% showed severe distress on the Impact of Events Scale-Revised questionnaire; and 4.0% had severe insomnia according to the Insomnia Severity Index.
Writing in Clinical Breast Cancer, Chuang and co-authors note that the scores they observed “were significantly higher than [those seen in breast cancer] patients under normal conditions in previous studies which showed about only 3.5% patients reported severe anxiety and depression, indicating an additional increase of mental stress on the [breast cancer] patients by COVID-19 crisis.”
Multivariate analyses, adjusted for potential confounders, revealed that poor general condition, namely with comorbidities, was the factor that was independently associated with all four PRO measures, at odds ratios (ORs) ranging from 1.77 for distress to 2.20 for insomnia.
“Thus more attention should be paid and some effective measures should be taken to reduce the stress during the COVID-19 crisis among patients with comorbidities,” Chuang et al remark.
In addition, an increased likelihood of anxiety was significantly predicted by close contact with COVID-19 patients (OR=3.18), shorter time from diagnosis (<4 months; OR=2.34), and aggressive molecular subtypes (OR=1.86).
CVC flushing delay was significantly associated with depression (OR=2.28) while treatment discontinuation was significantly associated with distress (OR=1.63).
Chuang and team conclude that their study “indicates that the psychological status of [breast cancer] patients deserves more attention during [the] COVID-19 pandemic.”
They add: “Effective measures should be taken to minimize mental health issues and to provide psychological support.”
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