A Survey on Physical and Mental Distress among Cancer Patients during the COVID-19 Epidemic in Wuhan,China

Abstract

Dear Editor:

The epidemic of Coronavirus Disease 2019 (COVID-19) was first identified in Wuhan, China. Medical services were suspended due to the increasing COVID-19 patients' volumes. In such a crisis, cancer patients are vulnerable and might experience physical and mental distresses. We aimed to explore the intensity of physical and mental distress among cancer patients during the epidemic.

1. What kind of survey was conducted?

A 53 question survey on the patients' perception of the impact of COVID-19, the Edmonton Symptom Assessment System Scale (ESAS),¹ and the Hospital Anxiety and Depression Scale (HADS)² was conducted.

A total of 129 confirmed cancer patients hospitalized completed the surveys. The response rate was 64.5%.

This survey was approved by the Institutional Review Board of Huber Cancer Hospital.

Anxiety or depression was defined if the HADS-A or the HADS-D scale was scored ≥8.³

2. What did the survey show?

The results of HADS showed 69 (53%) patients and 65 (50%) patients had anxiety and depression, respectively (Table 1).

All symptoms assessment scores on ESAS were mild except financial distress (4; interquartile range 0–7) (Table 1).

The vast majority of patients expressed fear of becoming infected themselves (85%) or their family (91%), and of cancer progression due to treatment delay (91%). In total 127 participants (98%) reported that their life was affected by COVID-19, and 91 participants (70%) reported that they needed mental support.

Patients liked that doctors wear masks and gloves as a demonstration of concern about their health (95%).

3. What are the key messages?

In the crisis of COVID-19, more than half of cancer patients had anxiety and depressed mood and COVID-19-related fear.

These findings suggest that cancer patients admitted during the epidemic need psychosocial support focused of COVID-19-related fears.

It is reassuring to see that mask and gloves that pose a barrier to communication and care were perceived as positive by the vast majority of patients in the context of the epidemic.

Table 1.

Participants' Edmonton Symptom Assessment System Scale and Hospital Anxiety and Depression Scale (n = 129)

HADS, no. of patients (%)
Anxiety (≥8)	69 (53)
Depression (≥8)	65 (50)
ESAS, median (IQR)
Pain	2 (0–4)
Fatigue	1 (0–4)
Nausea	0 (0–2)
Depression	0 (0–3)
Anxiety	1 (0–4)
Drowsiness	2 (0–4)
Appetite	2 (0–5)
Well-being	2 (0–5)
Dyspnea	0 (0–1)
Sleep	3 (0–5)
Financial distress	4 (0–7)
Spiritual pain	3 (0–7)

ESAS, Edmonton Symptom Assessment System Scale; HADS, Hospital Anxiety and Depression Scale; IQR, interquartile range.

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