Our study demonstrates several important findings concerning the psychological impacts of the COVID-19 pandemic among cancer survivors. Cancer survivors were more likely to report mental health symptoms, such as anxiety and depressive symptoms, compared with adults without a history of a cancer diagnosis. Additionally, certain demographic groups of cancer survivors were more likely to report mental health symptoms including younger adults, women, and cancer survivors without a high school degree. Cancer survivors with limited social interaction were also more likely to report mental health symptoms. Finally, we found that NH-Black cancer survivors may be less likely to report mental health symptoms compared with NH-White survivors. These findings may have implications for cancer care as poor mental health symptoms among cancer survivors may lead to barriers to successful treatment adherence and lower survival.
Although there are limited empirical studies that have compared the mental health impacts of COVID-19 among cancer survivors with the general population, prior studies have documented that cancer survivors have unique emotional needs related to anxiety and depression because of fear of recurrences as well as family and interpersonal strain. For example, a cross-sectional survey of patients with cancer in China observed a high prevalence of mental health problems, including depression, anxiety, post-traumatic stress disorder, and hostility during the COVID-19 pandemic. In the United States, a study using a nationally representative sample of adults showed a higher prevalence of anxiety and depressive symptoms during the COVID-19 pandemic, due in part to social isolation and economic hardship. Our study also suggests an important role of social support among cancer survivors during the COVID-19 pandemic.
We observed that cancer survivors were more likely to volunteer before the COVID-19 pandemic and also were more likely to speak with their neighbors than other adults both before and after the start of the COVID-19 pandemic, indicating they may have stronger social networks. Although studies examining social network patterns during the COVID-19 pandemic among adults with and without cancer are sparse, prior studies have documented increased likelihood of participation among online social support groups and health-related Internet use among cancer survivors compared with those without a cancer history. Increased anxiety, depression, loneliness, and hopelessness among cancer survivors is of major concern because of the potential impacts on quality of life and adherence to cancer survivorship recommendations, including required continuing treatment or wellness recommendations such as exercise and eating healthy.
Recent work demonstrates that cancer survivors are at higher risk of suicide in comparison with the general population, further underscoring the significance of evaluating mental health symptoms during the COVID-19 pandemic. Social isolation and deteriorated mental health symptoms during the COVID-19 pandemic can be an additional suicide risk during these unprecedented times. Providers should prioritize evaluating mental health symptoms among cancer survivors during their patient-provider interactions; however, recent data demonstrate that cancer survivors are canceling their doctor’s appointments during the COVID-19 pandemic, which may reduce opportunities to interact with patients (15). To address the needs of cancer survivors, many cancer survivorship programs in the United States have converted to telehealth and certain programs have seen success particularly when insurance reimbursement was extended to cover group behavioral telehealth interventions in response to the needs of patients during COVID-19. However, although advances in telehealth offer potential for accessible psychosocial care, significant barriers exist to equitable ease of use and access to the Internet and general technology. Alternative and creative programs, such as group visits, to scale up mental health treatment, are needed to ensure equitable access to care and address the needs of cancer survivors.
A notable strength of our analysis is we used nationally representative survey data and therefore obtained a representative sample of cancer survivors in the United States. However, our results should be interpreted with several limitations in mind. We relied on self-report of symptoms reported in the 7 days before survey administration. Chronic conditions, including a prior cancer diagnosis, were based on self-report, leading to the potential for measurement error in our definition of a cancer survivor. Although more reliable, data on psychological distress measured using validated scales, such as the General Anxiety Disorder–7 (GAD-7), were not available. We were unable to measure and account for important cancer-related variables such as site, stage, or type of treatment (surgery, chemo, or radiation). We were unable to assess if the respondent was currently undergoing cancer treatment, and if so, how long they have been undergoing treatment or time since treatment. Importantly, data regarding the cancer survivor’s mental health symptoms before COVID-19 were unavailable, and therefore we are unable to conclude if the mental health symptoms are COVID-19–related or because of another cause. We conducted sensitivity analyses to address this concern; however, future research using existing longitudinal cohorts to compare mental health symptoms among cancer survivors before and after COVID-19 pandemic is needed.
In conclusion, we demonstrated that cancer survivors are reporting mental health symptoms during the COVID-19 pandemic. Providers should prioritize evaluating the mental health symptoms of cancer survivors and use established validated scales to diagnose clinical depression or anxiety to ensure survivors are engaging in the survivorship care they need. Optimizing equitable access to telehealth opportunities for engagement of survivorship care should be prioritized. Future qualitative research into experiences of cancer survivors during the COVID-19 pandemic to elucidate their experience and potential mental health impact should be conducted. As Internet-based interventions to promote social support among cancer survivors have been found to have a positive impact on psychological well-being and quality-of-life outcomes, future studies should engage cancer survivors through e-Health tools during times of social isolation and quarantine during the COVID-19 pandemic.