Covid-19 has caused pandemic in this century. It is important to encourage the public in general and vulnerable groups such as our study population to adopt precautionary behaviours, which is based on the correct knowledge of the epidemic and appropriate response. Many studies have examined the various levels of knowledge about infectious disease outbreaks, such as SARS, avian influenza and Covid-19 [6,7,8,9] in general population, but to our knowledge there is no study addressing knowledge of covid-19 in cancer patients in developing countries.
Jordan is a middle- income country with limited resources, thus the emphasis was to limit the spread of infection and this necessitated the total lockdown and the increase of public awareness which was done through different social media .
In our study 83.1% believed that cancer patients are more prone to get infected with covid-19 which could be true, Case series by Liang et al. (18 cases), Zhang et al. (28 cases) and Zhang et al. (67 cases) reported a higher prevalence of cancer patients with COVID-19 infections compared with the overall population (1 vs 0.29%) . Nevertheless only 46.3% thought that they may become infected.
Unless people have basic knowledge about the modes of transmission, they will not respond appropriately during an outbreak . In our study even though 96.5% knew that covid-19 can be transmitted through direct contact, only 62.7% knew that it can be transmitted through air droplets which can increase spread of infection, still 86.1% wore face masks when they get out and 85.6% wore gloves, this could be related to the instructions given through public television about protection from corona virus. The effectiveness of mask use for preventing infection, especially pandemic transmission in households, has been established .
Hand disinfectants significantly reduce viral counts on the hands , 88.1% of participants stated that they use disinfectants. At KHCC hand disinfectants is routinely placed in all areas of the hospital to be used by patients and accompanying persons to prevent the spread of infection at the facility as we are dealing with a vulnerable group, this may have increased the awareness of the importance of hand disinfection thus the high response rate.
All participants answered that they wash their hands frequently, handwashing is a well-established means of preventing infection [13,14], which is a good practice followed by the patients to reduce the risk of infection.
Many of the participants 75.1% believed that coming to the hospital increased the risk of infection. A study showed that during the pandemic almost 30% of cancer patients’ infection was suspected to be hospital-associated transmission , 76.1% believed that they are more prone to develop complications if they were infected, but according to published research, patients may be less prone to severe infections but are at a theoretical risk of a cytokine release syndrome that would exacerbate a COVID-19 infection [16–18].
Even though many believed that coming to the hospital may increase risk of infection with covid-19, 57.2% did not want to postpone their treatment. According to a previous study, in general, it is recommended that patients receiving curative cancer therapy should continue their treatment despite the potential risk of COVID-19 infection during anticancer therapy. Delaying treatment of metastatic disease results in deteriorated performance status, admission for symptom palliation, and progressive disease . Maybe our patients were afraid that their disease will progress if they were not treated, in addition they were certain, 97% of them that the hospital is taking all measures necessary to prevent spread of infection.
The outbreak of any emerging infectious agent leads to the emergence of dynamic and uncertain situations; therefore, such emergencies need prompt and appropriate response . This implies that protective health behaviour in case of emerging infectious diseases is more likely to be dependent on situational responses based on known preventive actions like social distancing . For this it is quite important to study what the patients know and practice to allow for proper guidance.
Several measures were taken by KHCC to reduce risk of infection, of these all out-patients’ clinics were closed to minimize contact between individuals and all surgeries were postponed for two weeks as per the recommendations of the Society of surgical oncology which assumed a delay of 3-6 months in non-emergency cases is acceptable based on the clinical opinion of the surgeon . No appointments for surgeries were given during lockdown as answered by the survey during the clinic phone call.
Most of the participants practiced social distancing 96%, this message was sent by the government as an effort to contain the disease. Even though people are not much concerned for avoiding avoid mass gatherings and adopting social distancing practices; however, when influenced by informative tools they tend to adopt it to avoid acquiring any infection as was the case in our study.
Patients were under lockdown and health workers were at risk of infection, Physicians and health systems worldwide were racing to adopt virtualised treatment approaches that obviate the need for physical meetings between patients and health providers , thus KHCC consultants did the clinics by phone. Online medical counselling and appropriate diagnosis and treatment of critical cases to minimize patients’ exposure to COVID-519 may be required during the virus outbreak as concluded by a previous study . Participants were asked about their experience with the phone calls, most of the patients were called by the hospital 82.1%, of them 57.7% were contacted by their primary physician and 81.1% were contacted by their clinical coordinators. Different procedures resulted from this call such as chemotherapy appointments, renewal of medications, diagnostic exams schedules and follow up appointments were given. Around 85% of patients were satisfied that they are being followed by their health care providers and 85.1% stated that all their medical problems were addressed. The findings of the 2018 US Agency for Healthcare Research and Quality’s (AHRQ) telehealth systematic review found “telehealth improved outcomes or that there was no difference between telehealth and the comparators across the settings and for the clinical indications studied  as was the case with KHCC patients. Most of the participants knew what to do if they were infected and only a minority believed that they may not seek treatment for fear of quarantine. We did calculations between groups to study if gender, age diagnosis, level of education, residence and treatment affected knowledge and practices of oncology patients but there was no statistical significant difference between all subgroups and this could be explained by the nationwide health information provided as well as the precautionary actions and information provided by KHCC about covid-19, 63.7% of patients said that the hospital provided them with the necessary information.