Far from being hobbled by fears of COVID-19, patients with lung cancer actually showed less depression and anxiety during the pandemic than their healthy peers, according to results from a new study by Arrato et al published in JNCCN–Journal of the National Comprehensive Cancer Network.
Researchers were surprised by the resilience of patients with lung cancer and speculated that the strength patients needed to face their cancer may have helped them cope more effectively with COVID-19 fears. In fact, more than twice as many healthy people in the study met criteria for clinical levels of anxiety and depression during the early months of the pandemic as did those with lung cancer.
“We were astounded at how resilient these patients [with lung cancer] were in coping with the threat of COVID-19, given they were already under very difficult health circumstances,” said study author Barbara L. Andersen, PhD, Professor of Psychology at The Ohio State University. “That’s not to say patients [with lung cancer] were unfazed by the pandemic—they did show concern. But they seemed better able to handle the stress than similar people without cancer.”
Barbara L. Andersen, PhD
Study Background and Details
Before the study, there was reason to believe that patients with lung cancer might not have coped so well, Dr. Andersen said. Other studies have shown that patients with lung cancer are the most emotionally distressed of all patients with cancer, with the greatest prevalence of mood and anxiety disorders.
“It would have been easy to assume that COVID would add further stress to these patients,” she said.
Data came from 76 patients with advanced-stage non–small cell lung cancer. They were all participants in the Beating Lung Cancer in Ohio (BLCIO) study, which began before the pandemic started.
All participants completed surveys about their psychological health when they were diagnosed with lung cancer, at least a year before the pandemic. They then completed similar surveys with added questions concerning COVID-19 between April and July 2020. These lung cancer patients were compared with a control group of 67 similar people who had not been diagnosed with cancer: older adults from Ohio who were current or former smokers, with comparable education and income levels.
The researchers already knew that patients with lung cancer were hit hard psychologically when they were diagnosed: about 40% of them were in the moderately to severely depressed range at that time. However, the patients showed lower levels of anxiety and depression during the pandemic than when they were diagnosed, Dr. Andersen said.
In addition, they were better off than their peers without cancer when evaluated during the pandemic. About 12% of patients with lung cancer had levels of depression high enough to be diagnosed as clinically depressed, compared with 28% of the control group. Similar results were found with anxiety.
Overall, compared to the controls without cancer, the patients showed significantly less stress about COVID-19, less worry about their family contracting the virus, and had greater success with social distancing.
The patients did have moderate concern about their lung cancer, which is not surprising, Dr. Andersen said, but that concern was of similar magnitude to the concern that the people in the control group had about their overall health.
For these patients, COVID-19 occurred in the midst of an ongoing life-threatening disease, cancer-related symptoms, and routines already disrupted by receiving treatment. The pandemic was just another challenge to overcome.— Barbara L. Andersen, PhD
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The results suggest that, for patients with lung cancer, COVID-19 was put into the context of their other health issues.
“For these patients, COVID-19 occurred in the midst of an ongoing life-threatening disease, cancer-related symptoms, and routines already disrupted by receiving treatment. The pandemic was just another challenge to overcome,” Dr. Andersen said. “But for the group without chronic conditions, COVID-19 was an unexpected source of stress and made them worry about their health in a way they weren’t used to.”
Dr. Andersen said the results don’t mean that depression and anxiety aren’t an issue for patients with lung cancer. Many patients are at risk, and doctors and other clinicians should continue to screen for these problems and refer patients who need it to psychological treatment. But there’s another message from the results, she said.
“It is a message of strength and resilience, of being able to persevere despite all the challenges. These patients showed incredible toughness during COVID and went about what they had to do and continued their treatment, despite their very difficult disease.”
Disclosure: Partial funding for the Beating Lung Cancer in Ohio study was provided by Pelotonia. For full disclosures of the study authors, visit jnccn.org.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.