Survey Explores Mental Health of Patients With NSCLC During COVID-19

Patients with cancer may be more resilient to COVID-19–related stressors, according to new research that showed those with advanced non–small cell lung cancer (NSCLC) coped with the pandemic better than many of their peers who did not have cancer.

The study, published in Journal of the National Comprehensive Cancer Network, revealed these patients exhibited less depression and anxiety than healthy peers, despite having to leave home regularly to receive treatment.

Patients with lung cancer are vulnerable to coronaviral pneumonias and acute respiratory distress syndrome, and if infected, they have a greater risk of dying from these complications, the authors explained. In addition, in the United States, lung cancer deaths account “for 25% more cancer deaths than deaths from prostate, breast, and colon cancers combined, partly because 84% of patients with lung cancer are diagnosed at an advanced stage.”

To compare patients’ psychological responses at diagnosis and those during COVID-19, and to compare their coping responses with cancer-free controls from the same community, the researchers analyzed data collected in Ohio between April and July 2020.

All patients (N = 76) had stage IV NSCLC, and 67 controls with similar sociodemographic information and smoking histories were recruited. Participants completed the online Brief Illness Perception Questionnaire, Patient Health Questionnaire-9 (PQH-9), and General Anxiety Disorder-7 (GAD-7) questionnaire using Qualtrics.

Those with NSCLC had a mean age of 62.6 years, were 40.8% female, were 80.3% White, and most of the tumors were adenocarcinoma (77.6%).

Analyses revealed:

• Depressive and anxious symptoms of patients with NSCLC were greater at diagnosis (P < .02) than during COVID-19, approximately 1 year later
• Patients and controls did not differ regarding concern, understanding, or perceived control over COVID-19 (P > .406)
• Patients with NSCLC reported significantly fewer depressive (β = −0.206; 95% CI, −4.142 to −0.355; P = .020) and anxiety symptoms (β = −0.196; 95% CI, −4.037 to −0.308; P = .023) than controls, after controlling for racial group, age, and smoking status
• Controls anticipated the COVID-19 threat would last longer, practiced more social distancing, were more concerned about family (P < .04), and reported worse psychological symptoms (P < .023) than patients
• For controls, COVID-19 was more salient (ie, novel, unexpected), heightening worries and psychological symptoms

“It is important to understand and appreciate how patients with NSCLC with the most severe disease burden and symptom severity—ones uniquely susceptible to COVID-19 infection and death—are emotionally and behaviorally able to travel to the hospital and receive treatment, monthly if not weekly,” the researchers noted.

Prior to conducting the study, some investigators hypothesized patients’ PHQ-9 and GAD-7 scores would be elevated. These notions were proven wrong, as the authors outlined patients’ resiliency in the face of the pandemic, defining the term as “adapting well in the face of adversity, trauma, tragedy, threats, or significant stress.”

A potential explanation for the divergence in responses could be the fact that “COVID-19 for patients with NSCLC occurred in the midst of ongoing life threat, comorbidities, symptoms, and routines already disrupted by receiving cancer treatment,” the authors wrote.

However, they stressed the importance of utilizing American Society of Clinical Oncology–recommended measures for depression and anxiety at the time of diagnosis and thereafter for patients with NSCLC.

Reference

Arrato NA, Lo SB, Coker CA, et al. Cancer treatment during COVID-19: resilience of individuals with advanced non-small cell lung cancer versus community controls. J Natl Compr Canc Netw. Published online February 2022. doi:10.6004/jnccn.2021.7076