Distress and quality of life among treatment-naïve patients before and during COVID-19 pandemic

Introduction: The COVID-19 pandemic has dramatically impacted the way patients with cancer may request and receive psychosocial support. Thus, patient-reported outcomes (PROs) have become even more critical in the identification of patients with high distress. Objective: This study compares differences in psychosocial outcomes (distress and quality of life (QOL)) reported by patients newly diagnosed with cancer data before and during the COVID-19 pandemic. Methods: This cross-sectional study included all treatment-naïve patients from a single institution located in Brasília, Brazil. Patients were assessed upon treatment initiation for distress (Distress Thermometer) and QOL (Functional Assessment of Cancer Therapy-General). Descriptive statistics were generated and paired-sample t-test to compare levels of distress and QOL between two-time period of assessment (before and during COVID-19 pandemic). Results: A total of 385 consecutive treatment-naïve patients (before: 314 patients; during COVID-19: 73 patients) were included in this analysis. The majority were women (67%) with a median age of 57 years (range: 18-89). The most prevalent cancers were breast (26%), gastrointestinal (23%) and hematologic (22%), and the majority of patients possessed advanced disease (56%). Patients’ characteristics were similar between the two groups of patients. Patients receiving treatment during the pandemic reported higher levels of distress (M=4.1; SD=2.9), compared with those who received treatment before the pandemic (M=3.1; SD=1.4)(P=0.001). Similarly, patients reported worse mean QOL scores during COVID-19 (M=79.9; SD=13.7) compared to those patients treated before the pandemic (M=86.1; SD=13.3)(P=0.001). Similar findings were noted for all FACT-G subscales (physical, social/family, and functional well-beings). Notably, whereas no telehealth assessment of PROs were performed prior to the pandemic, 41% of those completed during the COVID-19 pandemic utilized a telehealth medium. Conclusion: We demonstrated that patients initiating treatment for cancer during the COVID-19 pandemic are managing significant emotional, physical, social/family, and functional morbidities. PRO screening tools can help identify those at greatest risk of emotional burden during these unprecedented times and permit supportive care departments to provide the appropriate resources and support.