Cancer care during and after the pandemicBMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2622 (Published 02 July 2020) Cite this as: BMJ 2020;370:m2622
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We read with great interest the article by Neal et al. describing the impact of COVID-19 on cancer care. (1) We write to highlight that the mental health needs of cancer patients are amplified during this challenging period, representing an additional, often overlooked aspect of care provision that needs to be addressed.
According to Cancer Research UK, over 2.4 million people in the UK have experienced delays in cancer screening, diagnostic tests or treatment services, with treatment rates reduced by as much as 50%. (2,3) Accordingly, an increased prevalence of mental health symptoms such as low mood, anxiety and insomnia in cancer patients have been reported during this pandemic. (4) Anxiety is further heightened due to the fear of COVID-19 infection, since cancer patients are an at-risk subgroup that have a poorer prognosis. (5) This anxiety has consequences on cancer care decision-making, with patients more likely to refuse treatments primarily due to the perceived risk of infection in healthcare settings. (6) As such, concerns regarding the long-term clinical outcomes for these patients and subsequent mental health have been raised. Moreover, many cancer patients have been advised to ‘shield’ for many months, often socially isolated from their loved ones, with some unable to carry out their end-of-life wishes. This not only contributes to depressive symptoms in patients, but may also detriment the grieving process for loved ones.
Certain subgroups of cancer patients are at higher risk of developing mental health symptoms. Notably, individuals from racial and ethnic minority or lower socio-economic backgrounds may comprise a disproportionately affected subgroup due to disparities in cancer screening, early detection and mortality as well as access to mental health services. (7,8) Other risk factors include disease recurrence, poor social support and low income - identifying these at-risk individuals could improve allocation of mental health services. (9)
Safeguarding the mental health of our cancer patients will initially require optimisation of their medical care during the pandemic. Designated mental health care providers within the cancer team may provide a useful point of contact for individuals struggling with mental health symptoms. This may be supplemented by community services (e.g. Mind, Every mind matters, CRUK cancer chat, Macmillan) and healthy lifestyle advice (e.g. balanced diet, physical activity, virtual socialising). Heightened awareness and further research into the unique mental health burden faced by cancer patients during pandemic contexts may help mitigate psychiatric sequelae and optimise their well-being.
1. Neal RD, Nekhlyudov L, Wheatstone P, Koczwara B. Cancer care during and after the pandemic. BMJ [Internet]. 2020 Jul 2 [cited 2020 Jul 11];370. Available from: https://www.bmj.com/content/370/bmj.m2622
2. Mahase E. Covid-19: Cancer Research urges mass testing to enable care to continue during pandemic. BMJ [Internet]. 2020 Apr 17 [cited 2020 Jul 11];369. Available from: https://www.bmj.com/content/369/bmj.m1561
3. Cancer Research UK. Over 2 million people in backlog for cancer care [Internet]. Cancer Research UK. 2020 [cited 2020 Jul 12]. Available from: https://www.cancerresearchuk.org/about-us/cancer-news/press-release/2020...
4. Zheng X, Tao G, Huang P, He F, Shao X, Xu Y, et al. Self-Reported Depression of Cancer Patients Under 2019 Novel Coronavirus Pandemic. 2020 Mar 12 [cited 2020 Jul 12]; Available from: https://papers.ssrn.com/abstract=3555252
5. Kuderer NM, Choueiri TK, Shah DP, Shyr Y, Rubinstein SM, Rivera DR, et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020 20;395(10241):1907–18.
6. Vanni G, Materazzo M, Pellicciaro M, Ingallinella S, Rho M, Santori F, et al. Breast Cancer and COVID-19: The Effect of Fear on Patients’ Decision-making Process. In Vivo. 2020 Jan 6;34(3 suppl):1651–9.
7. Gray TF, Cudjoe J, Murphy J, Thorpe RJ, Wenzel J, Han H-R. Disparities in Cancer Screening Practices among Minority and Underrepresented Populations. Seminars in Oncology Nursing. 2017 May 1;33(2):184–98.
8. Manuel JI. Racial/Ethnic and Gender Disparities in Health Care Use and Access. Health Serv Res. 2018 Jun;53(3):1407–29.
9. Anuk D, Özkan M, Kizir A, Özkan S. The characteristics and risk factors for common psychiatric disorders in patients with cancer seeking help for mental health. BMC Psychiatry [Internet]. 2019 Sep 3 [cited 2020 Jul 12];19. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6724340/
Competing interests: No competing interests