Cancer Patients’ Health Related Quality of Life (HRQoL) and Its Predictor Factors during the COVID-19 Pandemic: A Cross-sectional Survey Study in China

doi:10.21203/rs.3.rs-2240813/v1

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Cancer Patients’ Health Related Quality of Life (HRQoL) and Its Predictor Factors during the COVID-19 Pandemic: A Cross-sectional Survey Study in China

https://doi.org/10.21203/rs.3.rs-2240813/v1

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Objective

To evaluate Chinese cancer patients’ health related quality of life and its predictor factors during the COVID-19 pandemic.

Method

We conducted an online cross-sectional survey study among Chinese cancer patients in 2020 around China by utilizing the validated Mandarin version of COVID-19 IHRQOL questionnaire.

Results

387 patients participated in this survey, in which 283(72.9%) patients worried the pandemic’s impact on their cancer care, 69% feared getting infected by COVID-19. 30.7% and 17.3% patients had experienced depression and social isolation. More than 80% patients reported perceived benefits such as feeling more grateful. 26.3% patients reported financial hardship and 44.9% reported cancer care disruption. Multivariate analyses showed that more financial hardship was significantly associated with higher level of COVID-19 specific distress (p < 0.001).

Conclusion

Addressing health care services disruption and financial hardship, as well as promoting functional social support might help Chinese cancer patients acquire better HRQoL during the pandemic.

Biological sciences/Cancer

Biological sciences/Psychology

COVID-19

Health Related Quality of Life

Cancer

Chinese

Survey Study

The current study is one of the first to evaluate Chinese cancer patients’ health related quality of life (HRQoL) during the COVID-19 pandemic in China by utilizing the validated COVID-19 impact HRQoL questionnaire. Our results provide important evidence on Chinese cancer patients’ specific distress, concerns and perceived benefits during this period and related predictor factors. In addition, the utilization of a universal questionnaire could also provide comparable data for international studies in this field.

Till 2022, three years have passed since COVID-19 first outbroke in Wuhan and the Omicron SARS-CoV-2 variant is now still spreading in China and globally[1, 2]. Chinese national data in 2020 showed that cancer patients who were infected by COVID-19 had higher risk of severe disease condition or mortality[3, 4]. On the one hand, the prevention and precaution strategies in China mainland, which focus on screening for high-risk population and areas, were critical to protect cancer patients from getting infected. However, the dynamic zero-COVID policy might impact Chinese cancer patients’ treatments and medical care services in certain aspects[5]. In 2020, our research team had found that nearly 50% colon cancer patients who participated in a multicenter randomized controlled clinical trial had experienced delay or regimen modification of adjuvant chemotherapy due to COVID-19 pandemic[6]. A study in Zhejiang province revealed that cancer treatment delay was associated with higher level of general psychological distress among Chinese cancer patients[7].

In addition to health care disruption related worries and concerns, cancer patients also experienced anxiety, depression, sleeping disorders and fear of cancer progression during COVID-19 pandemic[8-10]. To better evaluate and address cancer survivors’ needs during this special period, health-related quality of life (HRQoL) had been applied to comprehensively assess the level of symptoms, wellbeing and perceived benefits or concerns in many countries[11, 12]. In 2020, MD Anderson Cancer Center (MDACC) developed a ‘COVID-19: Impact of The Pandemic and HRQoL in Cancer Survivors (COVID-19 IHRQOL)’ questionnaire to specifically investigate the level of cancer related HRQoL during the pandemic(ClinicalTrials.gov NCT04447222), which had been translated into many other languages after publication[13-15]. Due to socioeconomic disparities in different countries, the levels of HRQoL among cancer patients during COVID-19 pandemic were found to be associated with different factors such as treatment delay, lower level of physical activities and so on[16, 17]. However, so far, there is still limited knowledge on the HRQoL of Chinese cancer patients during the pandemic.

At the same year in 2020, the MDACC integrative medicine team invited our research team (leading investigator Professor Yufei Yang) to validate the COVID-19 IHRQOL questionnaire and utilize this tool to evaluate cancer patients’ HRQoL in China. The current study aimed to investigate the level of HRQoL and its impact factors among cancer patients in China through web based cross-sectional survey study to better address their needs and promote overall quality of life.

Study design and sample

Between June 2020 and August 2020, we conducted a cross-sectional survey study among cancer survivors in China through web-based questionnaire. We recruited Chinese patients from Beijing, Jiangsu, Guangzhou, and Shanghai. Inclusion criteria included precious cancer diagnosis and age older than 18. The ethical committee of Xiyuan Hospital of China Academy of Chinese Medical Sciences approved the study protocol after quick review under the waiving policy of COVID-19 related non-interventional study. No identification information was collected, and visual informed consent was provided at the beginning of the online survey for all participants. Convenience samples were collected during the one-month study period. The research team calculated the sample size according to the number of items(37) in the questionnaire in which 8-10 samples were adequate to detect the statistical value of each item. The final sample size was defined as 400 in consideration of drop-off and uncomplete data. The current study was conducted under the Strengthening the Reporting of Observational studies in Epidemiology(STROBE) guideline.

Questionnaire forward and backward translation

The original COVID-19 IHRQOL questionnaire was developed by MDACC (Leading principal investigator: Dr. Lorenzo Cohen), who authorized the copyright of validating and utilizing this questionnaire in China to our research team. Two individual researchers (GLY and LYS) whose mother language was Mandarin and had received clinical research training in the United States translated the questionnaire forward into Chinese independently. After reaching a consensus to any disparities of the translations, the preliminary Chinese version of the questionnaire was sent to a bilingual speaker (JHZ) for backward translation, whose mother languages were English and Mandarin. The research team compared the forward and backward translations together to finalize the Chinese version of COVID-19 IHRQOL questionnaire, which was approved by MDACC research group.

Data collection

Primary outcome

In COVID-19 IHRQOL questionnaire, the COVID-19 Specific Distress(COVID-19 SD) scale contained 12 different questions asking participants about to what degree did they agree with the following statements since the breakout of the COVID-19 pandemic: (1) I feel anxious about getting COVID-19 (or if positive: I am anxious about becoming ill); (2)I worry about possibly infecting others;(3)I am concerned about a family member or close friend getting or dying from COVID-19;(4)I worry about the possibility of dying from COVID-19;(5)I fear how the COVID-19 pandemic will impact my cancer care or recovery;(6)I feel I have no control over how COVID-19 will impact my life;(7)I have experienced feelings of sadness or depression;(8)I feel negative about the future;(9)I have experienced changes in my sleep;(10)I have experienced changes in my eating;(11)I have experienced difficulty concentrating;(12)I have experienced feelings of social isolation. 5-Likert scale was used to score the scale: 0=Strongly Disagree;1=Disagree;2=Neither agree or Disagree; 3=Agree; 4=Strongly Agree. According to our data collected in the current study, the Cronbach’s alpha coefficient of this scale was 0.928, indicating a good reliability. Then the total score of COVID-19 SD scale was summarized and higher score indicated that cancer patients might suffer from more COVID-19 specific distress (score range 0-48).

Secondary outcomes

Secondary outcomes included Perceived Benefits scale (COVID-19 PB) and Perceived Stress Management scale (COVID-19 PSM) in COVID-19 IHRQOL questionnaire. The COVID-19 PB scale contained four statements as following: Since the breakout of the COVID-19 pandemic (1)I have greater appreciation for my family and close friends;(2) I have deeper appreciation for life;(3) I have been more grateful for each day;(4)I have been more accepting of things I cannot change. The COVID-19 PSM scale contained five statements including: Since the breakout of the COVID-19 pandemic (1) I am able to recognize thoughts and situations that make me feel stressed or upset about COVID-19;(2) I am able to practice relaxation (e.g., deep breathing, meditation) when feeling stress about COVID-19;(3) I am able to seek information and plan accordingly to address concerns over the COVID-19 pandemic;(4) I can re-examine negative thoughts and gain a new perspective when concerned about COVID-19;(5)When I'm going through a very hard time, I give myself the caring and tenderness I need. All statements above were measure by 5-Likert scale: 0=Strongly Disagree;1=Disagree;2=Neither agree or Disagree; 3=Agree; 4=Strongly Agree. The Cronbach’s alpha coefficients of COVID-19 PB and COVID-19 PSM scale were 0.939 and 0.947.

Predictor factors

Predictor factors were defined as the following information which had been collected through the COVID-19 IHRQOL questionnaire: (1)Risk factors or experienced symptoms associated with COVID-19(including eight risk factors, 60 years of age, Comorbidities such as diabetes, hypertension and/or respiratory illnesses, International travel or travel to COVID-19 hotspots, Exposure to someone who tested positive to COVID-19, Visiting/working in a nursing home or hospital, Fever, Dry cough, Shortness of breath);(2) Health Care Disruptions and Concerns (Concerns About Medical Care, 4 questions);(3) Disruption to Daily Activities and Social Interactions(4 questions);(4) Financial Hardship(4 questions);(5) Functional Social Supports(4 questions). Statements (2) to (4) were measure by 5-Likert scale: 0=Strongly Disagree;1=Disagree;2=Neither agree or Disagree; 3=Agree; 4=Strongly Agree.

Basic information

Patients’ basic information such as gender and age were collected, as well as their disease information such as cancer type, time since cancer diagnosis and whether under active cancer treatments or not.

Statistical analysis

Descriptive data including continuous variables (age and total scores of COVID-19 SD, PB and SM scales) were calculated by mean and standard deviation (SD), while categorized variables (gender, cancer type, risk factors and patients’ answers to different questionnaires) were calculated by counts and proportion. For the following four predictor factors (financial hardship, health services disruption, daily activity interruption and functional social support), we transformed them into two category variables according to the mean total score of each factors (e.g. health care disruption was defined as ‘less’ if the mean total score of this scale was lower than 6.51). Independent two-sample t-test was used to determine the differences of primary outcomes between different predictor factors for univariate analyses. Linear regression model was used to evaluate independent predictor factors (those showed significant differences in univariate analyses) for both primary and secondary outcomes (COVID-19 SD, PB and SM scales). P value indicates statistically significant difference if it is lower than 0.05. All statistics were performed through SPSS 26.0 (IBM corp.).

Patients’ information and exposures to COVID-19

Among 400 patients who participated in the survey, 387 of them completed all the questionnaires and were finally analyzed. The mean age of participants was 59(SD 11) years’ old and 66.1% were female patients. There were 39.4% colorectal cancer, 24.7% breast cancer, 10.3% lung cancer and 7.5% stomach cancer patients participated in the study (Table 1). 63% patients were under active cancer treatments at the time of survey. None of the participants nor their family members and friends were diagnosed with COVID-19. However, five patients reported that they had been exposed to someone with COVID-19.

There were 31.2% patients reported at least one risk factor that associated with COVID-19, while 21.4% reported two and more risk factors. Among the eight risks listed in COVID-19 IHRQOL questionnaire, 40.5% patients reported risk of age older than 60, 20.1% had comorbidities such as diabetes and hypertension and 13.7% had been to medical settings.

Primary outcome: COVID-19 Specific Distress (Emotional and Physical Reactions)

Among 12 COVID-19 specific distress, 283 patients (72.9%) worried that the pandemic would impact their cancer care or recovery, 268(69%) concerned that their family members or close friend getting infected by COVID-19, 258(66.5%) worried that themselves getting infected. There were 119(30.7%) patients who had experienced sadness or depression during this period and 67(17.3%) had experienced social isolation(Figure1). The mean total score of COVID-19 specific distress was 23.62(SD 11.52).

Secondary outcomes: Perceived benefits and stress management

Among four perceived benefits during COVID-19 pandemic, 88.9% patients agreed that they had been more grateful for each day, 87.4% and 86.9% patients had deeper appreciation for their family members and friends, as well as their own lives(Figure 2). The total score of COVID-PB scale was 12.61(SD 3.13). Female patients had higher level of perceived benefits than males(12.16±2.92 vs. 12.82±3.21, p=0.042, Table 1).

For perceived stress management, there were 79.4% patients who agreed that they could re-examine negative thoughts and gain a new perspective when concerned about COVID-19, and same proportion of patients had given themselves the caring and tenderness they need when they were going through a very hard time. In addition, 78.6% patients were able to recognize thoughts and situations that make me feel stressed or upset about COVID-19(Figure 2). The total score of COVID-19 SM scale was 14.43(SD 13.76). Patients who had at least one risk factors that associated with COVID-19 had better stress management ability than those who had no risk factor (14.91±3.34 vs. 13.89±4.12, p=0.008, Table 1).

Other predictor factors

Financial Hardship

According to financial hardship questionnaire in COVID-19 IHRQOL，there were 39.1% patients reported that they had not been able to adequately provide for others they financially supported during the pandemic, while 26.3% of them had experienced financial difficulties and 25.0% felt anxious about losing or having lost their jobs or their primary sources of income (Figure 3-A). Patients who had more perceived financial hardship had higher level of COVID-19 specific distress (29.30±9.63 vs. 18.97±10.84, p<0.001), but less skills of stress management (13.97±3.25 vs. 14.80±4.10, p=0.029, table 1).

Health Care Disruptions and Concerns (Concerns About Medical Care)

There were 174 patients’ cancer treatments or surveillance had been interfered or delayed due to COVID-19, as well as 175 patients’ basic medical care services had been interfered or delayed. However, more than 70% patients reported that their medical care team had prepared and provided enough information on COVID-19 precaution and nursing care (Figure 3-B). Patients who had more health care disruptions and concerns were associated with less perceived benefits (12.29±3.53 vs. 13.06±2.38, p=0.011) and stress management skills (13.95±4.09 vs. 15.11±3.12, p=0.002, table 1).

Disruption to Daily Activities and Social Interactions

209 patients reported that they and their families’ daily life had been interfered due to COVID-19 and 167 patients agreed that they could not give their family and friends enough care. In addition, 143 patients could not continue their daily activities and 55 reported that they had contradiction with their family members(Figure 3-C). Patients who had higher daily activity interference were significantly associated with higher level of COVID-19 specific distress (29.28±8.92 vs. 17.04±10.68, p<0.001).

Functional Social Support

Nearly 90% patients agreed that they had received emotional support from family or friends when they needed, while could be there to listen to other’s problems when needed (Figure 3-D). Patients who had more functional social supports had significantly more perceived benefits (14.95±1.83 vs. 11.55±3.02, p<0.001) and better stress management skills (16.81±3.18 vs. 113.34±3.50, p<0.001, table 1).

Multivariate analyses

Multivariate analysis showed that after controlling gender and age, more financial hardship and daily activities disruptions were significantly associated with higher level of COVID-19 specific concerns (Table 2-1, p<0.001). Female patients and patients who had more functional social support had more perceived benefits, but patients who had more medical service interference had less perceived benefits (Table 2-2). Patients who had more risk factors associated with COVID-19 and more functional social supports had better perceived stress management, while patients had more health care disruptions had worse perceived stress management (Table 2-3).

In this study, we characterized Chinese cancer patients’ HRQoL including COVID-19 specific concerns, perceived benefits, and stress management during the pandemic, as well as their predictor factors. Notably, Chinese cancer patients mainly worried that COVID-19 might interrupt their cancer care or infect them. Despite the negative influence of the pandemic, patients still reported various perceive benefits such as being grateful and having more appreciation to family and friends, as well as good coping skills to manage stress they would face. Weighing up losses and gains to cancer patients during the pandemic, we found that less financial hardship and health care disruptions, as well as more functional social supports could help them reduce COVID-19 specific distress and acquire more perceived benefits and better stress managements. To the best of our knowledge, this is one of the first study to evaluate cancer patients’ HRQoL in China during COVID-19 pandemic, highlighting opportunities and strategies for improving cancer care during this period.

Previous survey studies in China revealed that the prevalence of anxiety or depression among cancer patients during COVID-19 pandemic was about 15.5% to 39.7%, compared with 6.3% depression rate among general population in China during this period[8, 18-20]. In our study, the proportion of patients who reported experiencing sadness or depression was 30.7%, which was consistent with previous findings. However, according to survey studies and literature review, the incidence of anxiety or depress among cancer patients in other western countries during COVID-19 pandemic was about 33.5% to 47%[14, 21, 22]. Although Chinese cancer patients might experience less psychological distress compared with patients from western countries, they still need more professional psychosocial support which has not been fully addressed. Notably, existing data showed that 50% to 67% cancer patients felt exacerbated social isolation or loneliness during the pandemic, which further impacted patients’ overall quality of life[23-25]. Comparingly, 17.3% Chinese cancer patients in our study reported that they felt social isolation. According to our results, the majority of Chinese cancer patients had received supports from family members and friends, and they could also help others when they needed as well. In addition, more functional social support was found to be independently associated with less COVID-19 specific distress, as well as more perceived benefits and stress management during the pandemic. Such disparities might be associated with social-cultural differences between western and Chinese societies[26].

Health care disruption was Chinese cancer patients’ major concern during the pandemic and was also found to be independently associated with patients’ distress, perceived benefits, and stress managements. Compared with Ludwigson’s study, there were more patients whose cancer care or follow-up had been disrupted by the pandemic in China than in the US (44.9% vs. 18%). As results, there were more cancer patients in China who worried that the pandemic would impact their cancer care or recovery than in the US(72.9% vs. 44.9%) according to our study. In China, most cancer patients receive cancer care in major big cities such as Beijing, Shanghai, and Guangzhou, which could be disrupted due to COVID-19 dynamic precaution strategies, quarantine, and transportation block. might influence their routine treatments or follow-up. According to clinical data in China, treatment delays including immunotherapy and chemotherapy for at least two months did not show significant negative impacts on cancer disease control[27, 28]. However, longitudinal studies are necessary to evaluate the long-term effects of treatment delay to cancer patients’ survival outcomes. Oncologists in China also tried to implement active and effective measures for cancer care during the pandemic including establishing appointment schedule system, highly efficient COVID-19 screening procedure, and switch anti-cancer medication from infusion to oral[29]. In addition, primary care and family physician system, as well as remote online or telephone-based consultation could also help meet cancer patients’ basic medical service needs during the pandemic[30, 31].

Although the COVID-19 pandemic has brought numerous distresses and hardship to cancer patients in China, there were still 66.5% patients in our study who agreed that they were satisfied with the current condition. According to Chinese patients’ perceived benefits, they had become more grateful for daily life as well as their care givers and acquired better stress management skills at the same time. A previous psycho-oncology study showed that better satisfaction to life and coping strategies could both promote posttraumatic growth and resilience in cancer survivors[32, 33]. Another study in Australia hold the view that the pandemic had brought certain benefits including disruption of the risk of overdiagnosis of cancer screening[34]. A Chinese study found that the quarantine during COVID-19 pandemic resulted in less air pollution which might be associated with lower rate of infectious diseases transmission[35]. Researchers also purposed innovative cancer treatment strategies, for example SARS-CoV-2-specific CD8(+) T cells for cancer immunotherapy[36]. Interestingly in our study, we found that patients who had more risk factors of getting infected by COVID-19 owned better stress management ability. Similarly, a survey study showed that compared with common population, cancer patients had less fear of being infected by COVID-19[37]. Thus, more education on COVID-19 related information for cancer patients could be helpful for them to reduce the fear of uncertainty.

There are certain limitations of our study. First, the current sample size of the study was limited by research funding and timing. On the next step, our research team will authorize professional institutions to utilize the validated Mandarin version of COVID-19 IHRQOL to evaluate Chinese cancer patients’ HRQoL in wider area across China. Second, different types and clinical stages of cancer could result in distinct psychological and physical distress. For example, pancreatic cancer patients reported more symptoms burden during the pandemic than other cancer types[38]. Future large sample size study or survey study among specific cancer type could help better address this scientific question. In addition, the influence of COVID-19 on cancer patients could be impacted by dynamic change of epidemic period and areas. Thus, in addition to cross-sectional study, longitudinal study on certain cancer population cohort is also necessary to detect the long-term impact of COVID-19 to cancer patients’ quality of life and long-term survival outcomes. Nonetheless, the current study is still one of the first to provide evidences on the HRQoL of Chinese cancer patients during the COVID-19 pandemic.

In a conclusion, approximately 70% Chinese cancer patients worried about cancer care interruption and getting infected by the COVID-19 pandemic. More functional social support and less financial hardship or health care interruptions were all significantly associated with lower level of COVID-19 specific distress, as well as more perceived benefits and better stress management abilities during this period. Medical service providers and supportive care teams should dedicate more efforts to helping cancer patients having better access to health care resources and provide more information on both cancer care and COVID-19 coping strategies.

COVID-19, Corona Virus Disease 2019

COVID-19 IHRQOL, ‘COVID-19: Impact of The Pandemic and HRQoL in Cancer Survivors’(questionnaire)

COVID-19 SD, COVID-19 Specific Distress

COVID-19 PB, COVID-19 Perceived Benefits

COVID-19 PSM, COVID-19 Perceived Stress Management

HRQoL, Health Related Quality of Life

MDACC, MD Anderson Cancer Center

SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2

SD, Standard Deviation

US, United States

95% CI, 95% Confidential Interval

Ethical Approval

The ethical committee of Xiyuan Hospital of China Academy of Chinese Medical Sciences approved the study protocol after quick review under the waiving policy of COVID-19 related non-interventional study. No identification information was collected, and visual consent was provided at the beginning of the online survey for all participants.

Competing interests

The authors have no conflict of interest.

Authors' contributions

Lingyun Sun: Study design, statistical analysis and manuscript drafting

Rongyan Peng: Data collection and statistical analysis

Jiaxi Liu: Data collection

Yunzi Yan: statistical analysis and manuscript drafting

Haibo Zhang: Data collection and study design

Yufei Yang: Study design and administration support

Funding

This study is funded by Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences; Principal Investigator: Lingyun Sun MD; Grant number: C12021A01819.

Availability of data and materials

All data and related questionnaire of the study are available from the corresponding author by request.

Acknowledgement

We appreciate Professor Lorenzo Cohen from MD Anderson Cancer Center for inviting our research team to validate and utilize the COVID-19 IHRQOL questionnaire in China. We also thank Dr. Geliang Yang and Mr. Jiahan Zi for their assistants on the forward and backward translation processes of the questionnaire, as well as all participants in this survey for sharing their experiences during this special period. China Society Integrative Oncology affiliated with World Federation of Chinese Medicine Societies supported this study, and we thank our committee board members(Professor Aiwen Wu, Aiguang Zhao, Lili Tang, Li Hou, Jianghua Ou, Peng Shu) for patients’ recruitment.

Estimating global, regional, and national daily and cumulative infections with SARS-CoV-2 through Nov 14, 2021: a statistical analysis. Lancet, 2022.
Joshi, G. and R. Poduri, Omicron, a new SARS-CoV-2 variant: assessing the impact on severity and vaccines efficacy. Hum Vaccin Immunother, 2022. 18(1): p. 2034458.
Yang, K., et al., Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study. Lancet Oncol, 2020. 21(7): p. 904–913.
Liang, W., et al., Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol, 2020. 21(3): p. 335–337.
Xiao, H., et al., The impact of the COVID-19 pandemic on health services utilization in China: Time-series analyses for 2016–2020. Lancet Reg Health West Pac, 2021. 9: p. 100122.
Sun, L., et al., Impact of the COVID-19 outbreak on adjuvant chemotherapy for patients with stage II or III colon cancer: experiences from a multicentre clinical trial in China. Curr Oncol, 2020. 27(3): p. 159–162.
Ye, Y., et al., Psychological distress of cancer patients caused by treatment delay during the COVID-19 pandemic in China: A cross-sectional study. Psychooncology, 2022.
Yang, S., et al., The status of anxiety state among cancer patients and their relatives during coronavirus disease 2019 (COVID-19) in Hubei, China. Ann Palliat Med, 2021. 10(4): p. 4601–4611.
Juanjuan, L., et al., Patient-reported Outcomes of Patients With Breast Cancer During the COVID-19 Outbreak in the Epicenter of China: A Cross-sectional Survey Study. Clin Breast Cancer, 2020. 20(5): p. e651-e662.
Qian, Y., et al., A Survey on Physical and Mental Distress among Cancer Patients during the COVID-19 Epidemic in Wuhan, China. J Palliat Med, 2020. 23(7): p. 888–889.
Ellehuus, C., et al., Health-related quality of life of patients with haematologic cancer during COVID-19 and their opinions on telehealth consultations - a Danish single site cross-sectional survey. Acta Oncol, 2021. 60(7): p. 872–880.
Ikeda, T., et al., Health-Related Quality of Life during COVID-19 Pandemic: Assessing Impacts of Job Loss and Financial Support Programs in Japan. Appl Res Qual Life, 2021: p. 1–17.
Penedo FJ, C.L., Bower J, Antoni M., COVID-19: impact of the pandemic and hrqol in cancer patients and survivors. 26 May 2020 ed. OSF2020., 2020.
Ludwigson, A., et al., Patient Perceptions of Changes in Breast Cancer Care and Well-Being During COVID-19: A Mixed Methods Study. Ann Surg Oncol, 2022. 29(3): p. 1649–1657.
Dehkordi, A.H., et al., Examination of the psychometric properties of the persian version of the COVID-19-impact on Quality of Life Scale. Health Qual Life Outcomes, 2021. 19(1): p. 188.
Yildirim, O.A., K. Poyraz, and E. Erdur, Depression and anxiety in cancer patients before and during the SARS-CoV-2 pandemic: association with treatment delays. Qual Life Res, 2021. 30(7): p. 1903–1912.
Tabaczynski, A., et al., Changes in physical activity and associations with quality of life among a global sample of cancer survivors during the COVID-19 pandemic. J Cancer Surviv, 2022: p. 1–11.
Pi, H.M., et al., COVID-19-Related Knowledge and Practices of Cancer Patients and Their Anxiety and Depression During the Early Surge Phase of the Pandemic: A Cross-sectional Online Survey. Disaster Med Public Health Prep, 2022: p. 1–8.
Han, J., et al., Psychological symptoms of cancer survivors during the COVID-19 outbreak: A longitudinal study. Psychooncology, 2021. 30(3): p. 378–384.
Liu, W., et al., Prevalence of depression in China during the early stage of the COVID-19 pandemic: a cross-sectional study in an online survey sample. BMJ Open, 2022. 12(3): p. e056667.
Verma, R., H.M. Kilgour, and K.R. Haase, The Psychosocial Impact of COVID-19 on Older Adults with Cancer: A Rapid Review. Curr Oncol, 2022. 29(2): p. 589–601.
De Jaeghere, E.A., et al., Mental Health and Quality of Life among Patients with Cancer during the SARS-CoV-2 Pandemic: Results from the Longitudinal ONCOVID Survey Study. Cancers (Basel), 2022. 14(4).
Bartels, M., et al., Impact of the COVID-19 pandemic on quality of life and emotional wellbeing in patients with bone metastases treated with radiotherapy: a prospective cohort study. Clin Exp Metastasis, 2021. 38(2): p. 209–217.
Kirtane, K., et al., "I have cancer during COVID; that's a special category": a qualitative study of head and neck cancer patient and provider experiences during the COVID-19 pandemic. Support Care Cancer, 2022. 30(5): p. 4337–4344.
Howden, K., et al., Loneliness among adolescents and young adults with cancer during the COVID-19 pandemic: a cross-sectional survey. Support Care Cancer, 2022. 30(3): p. 2215–2224.
Santin, O., et al., Supporting someone with cancer during the COVID-19 pandemic: A mixed methods analysis of cancer carer's health, Quality of Life and need for support. Health Soc Care Community, 2022.
Chen, G., et al., Impact of treatment delay due to the pandemic of COVID-19 on the efficacy of immunotherapy in head and neck cancer patients. J Hematol Oncol, 2020. 13(1): p. 174.
Yi, Q., Y. Ran, and C. Li, The Effect of Delayed Chemotherapy on the Decrease of CA125 in Epithelial Ovarian Cancer During Coronavirus Disease Pandemic in 2020. Cancer Manag Res, 2021. 13: p. 515–520.
Wang, Z., J. Wang, and J. He, Active and Effective Measures for the Care of Patients With Cancer During the COVID-19 Spread in China. JAMA Oncol, 2020. 6(5): p. 631–632.
Price, S.T., A.G. Mainous, and B.J. Rooks, Survey of cancer screening practices and telehealth services among primary care physicians during the COVID-19 pandemic. Prev Med Rep, 2022. 27: p. 101769.
Narayanan, S., et al., Integrative Oncology Consultations Delivered via Telehealth in 2020 and In-Person in 2019: Paradigm Shift During the COVID-19 World Pandemic. Integr Cancer Ther, 2021. 20: p. 1534735421999101.
Adamkovič, M., et al., Relationships between satisfaction with life, posttraumatic growth, coping strategies, and resilience in cancer survivors: A network analysis approach. Psychooncology, 2022.
Shi, J., et al., Resilience and Posttraumatic Growth of Patients With Breast Cancer During the COVID-19 Pandemic in China: The Mediating Effect of Recovery. Front Psychol, 2021. 12: p. 811078.
Bell, K.J., et al., Considering potential benefits, as well as harms, from the COVID-19 disruption to cancer screening and other healthcare services. Public Health Res Pract, 2022.
Zhang, X., et al., Associations between air pollution and COVID-19 epidemic during quarantine period in China. Environ Pollut, 2021. 268(Pt A): p. 115897.
Gujar, S., et al., Repurposing CD8(+) T cell immunity against SARS-CoV-2 for cancer immunotherapy: a positive aspect of the COVID-19 pandemic? Oncoimmunology, 2020. 9(1): p. 1794424.
Ripamonti, C.I., 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, 2021: p. 3008916211022848.
Alexander, A., et al., Quality of Life in Patients with Pancreatic Cancer before and during the COVID-19 Pandemic. Int J Environ Res Public Health, 2022. 19(6).

Table 1. Univariable analyses on COVID-19 specific distress, perceived benefits, and stress management

	COVID-19 Specific Distress		Perceived Benefits		Stress Managements
	*Mean(SD)**	P value**	*Mean(SD)**	P value**	*Mean(SD)**	P value**
Gender
Male(n=131)	22.47(11.16)	0.16	12.16(2.92)	0.042*	14.33(3.64)	0.71
Female(n=256)	24.20(11.68)		12.82(3.21)		14.48(3.83)
Age		0.16
<=60(n=192)	24.42(11.51)		12.51(3.06)	0.71	14.11(3.73)	0.14
>60(n=183)	22.75(11.69)		12.63(3.25)		14.69(3.86)
Risk factor
None(n=184)	24.15(11.77)	0.40	12.43(3.35)	0.29	13.89(4.12)	0.008
>=1(n=204)	23.16(11.28)		12.77(2.91)		14.91(3.34)
Under Cancer treatments
No(n=141)	23.00(11.94)	0.42	12.80(3.32)	0.40	14.74(3.98)	0.21
Yes(n=247)	23.99(11.27)		12.50(3.01)		14.24(3.62)
Financial Hardship
Less(n=213)	18.97(10.84)	<0.001	12.64(3.32)	0.81	14.80(4.10)	0.029
More(n=175)	29.30(9.63)		12.57(2.89)		13.97(3.25)
Health Care Disruptions and Concerns
Less(n=160)	22.65(10.20)	0.16	13.06(2.38)	0.011	15.11(3.12)	0.002
More(n=228)	24.32(12.32)		12.29(3.53)		13.95(4.09)
Daily activity Interference
Less(n=179)	17.04(10.68)	<0.001	12.36(3.61)	0.15	14.53(4.44)	0.63
More(n=209)	29.28(8.92)		12.82(2.64)		14.34(3.07)
Functional Social Support
Less(n=267)	24.01(10.22)	0.39	11.55(3.02)	<0.001	13.34(3.50)	<0.001
More(n=121)	22.79(13.96)		14.95(1.83)		16.81(3.18)

Note: *Standard deviation, SD; ** Statistically significant difference if p value<0.05.

Table 2-1. Multivariate Analysis of Predictor Factors on COVID-19 Specific Concerns

	Coefficient	95%CI*	P value**
Constant	14.447
Gender
Male	0	-	-
Female	0.694	-1.379,2.767	0.511
Age
<=60	0	-	-
>60	0.643	-1.328,2.613	0.522
Financial Hardship
Less	0	-	-
More	5.197	2.856,7.538	<0.001
Daily Activities Disruption
Less	0	-	-
More	9.918	7.607,12.229	<0.001

Table 2-2. Multivariate Analysis of Predictor Factors on Perceived Benefits

	Coefficient	95%CI*	P value**
Constant	10.824
Gender
Male	0	-	-
Female	0.602	0.038,1.166	0.037
Under Cancer Treatments
No	0	-	-
Yes	-0.156	-0.715, 0.403	0.584
Daily Activities Disruption
Less	0	-	-
More	0.907	0.358,1.457	0.001
Health Care Disruption
Less	0	-	-
More	-0.869	-1.427, -0.311	0.002
Functional Social Support
Less	0	-	-
More	3.395	2.821, 3.970	<0.001

Table 2-3. Multivariate Analysis of Predictor Factors on Stress Management

	Coefficient	95%CI*	P value**
Constant	13.651
Age
<=60	0	-	-
>60	-0.201	-1.058, 0.655	0.645
Risk Factors
None	0	-	-
>=1	0.852	0.003,1.701	0.049
Financial Hardship
Less	0	-	-
More	-0.256	-0.977,0.465	0.485
Health Care Disruption
Less	0	-	-
More	-0.925	-1.642, -0.207	0.012
Functional Social Support
Less	0	-	-
More	3.392	2.642, 4.141	<0.001

Note: *95% Confidential Interval, 95%CI; ** Statistically significant impact factor if p value<0.05.

No competing interests reported.

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Cancer Patients’ Health Related Quality of Life (HRQoL) and Its Predictor Factors during the COVID-19 Pandemic: A Cross-sectional Survey Study in China

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