Cancer Treatment During COVID-19: Resilience of Individuals With Advanced Non–Small Cell Lung Cancer Versus Community Controls

Authors:
Nicole A. Arrato Department of Psychology,

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Stephen B. Lo Department of Psychology,

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Clarence A. Coker Department of Psychology,

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Jonathan J. Covarrubias Department of Psychology,

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Tessa R. Blevins Department of Psychology,

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 BA
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Sarah A. Reisinger Comprehensive Cancer Center,  and

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Carolyn J. Presley Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.

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Peter G. Shields Comprehensive Cancer Center,  and
Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.

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Barbara L. Andersen Department of Psychology,

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Background: Among all patients with cancer, those with advanced non–small cell lung cancer (NSCLC) experience the most distress. Although new therapies are improving survival, it is unknown whether receiving immunotherapy or targeted therapy during the COVID-19 pandemic increases patients’ psychological vulnerability. To meet clinical needs, knowledge of patients’ COVID-19 perceptions and safety behaviors is essential. Thus, this study compared patients’ psychological responses at diagnosis and during COVID-19 and compared patients with similar individuals without cancer during the same period. Patients and Methods: Patients with advanced NSCLC enrolled at diagnosis for cohort study participated (ClinicalTrials.gov identifier: NCT03199651). Those with follow-ups from April 28, 2020, through July 14, 2020 (n=76), were assessed again including COVID-19 measures. Simultaneously, community controls with similar sociodemographics and smoking histories were solicited (n=67). Measures were COVID-19 perceptions (Brief Illness Perception Questionnaire), social distancing, and depressive (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) symptoms. First, analyses evaluated differences in the psychological responses of patients with NSCLC at diagnosis and during COVID-19. Second, patients and controls were contrasted on COVID-19 perceptions, social distancing, and psychological symptoms. Results: The depressive and anxious symptoms of patients with NSCLC were greater at diagnosis (P<.02) than during COVID-19, approximately 1 year later. Patients with NSCLC and controls did not differ in terms of sociodemographics, except those with NSCLC were more racially diverse and older, and had greater smoking history (P<.03). Groups did not differ regarding concern, understanding, or perceived control over COVID-19 (P>.406). Notably, controls anticipated the COVID threat would last longer, practiced more social distancing, were more concerned about family (P<.04), and reported worse psychological symptoms (P<.023). With less depression and anxiety, patients with NSCLC viewed COVID-19 as a shorter-term threat and had fewer COVID-19–related worries than did controls. For controls, COVID-19 was more salient, heightening worries and psychological symptoms. Conclusions: Despite multiple health stressors, patients with NSCLC demonstrated resilience when receiving cancer treatment during COVID-19. Nonetheless, this population remains psychologically vulnerable, requiring support at diagnosis and thereafter.

Submitted February 22, 2021; final revision received June 7, 2021; accepted for publication June 18, 2021.

Author contributions: Study concept: Arrato, Andersen. Investigation: Arrato, Andersen. Data curation: Arrato, Coker, Covarrubias, Reisinger, Presley, Andersen. Formal analysis: Lo, Coker, Covarrubias. Funding acquisition: Shields. Methodology: Lo, Andersen. Supervision: Reisinger, Presley, Shields. Validation: Covarrubias. Writing – original draft: Arrato, Lo, Coker, Blevins, Andersen. Writing – review and editing: Arrato, Lo, Coker, Blevins, Reisinger, Presley, Shields, Andersen.

Disclosures: The authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported by funding from Ohio State University Comprehensive Cancer Center Pelotonia.

Correspondence: Barbara L. Andersen, PhD, Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210-1222. Email: Andersen.1@osu.edu

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