Adherence and perception of the importance of anti-COVID-19 protective measures amongst patients with cancer.
Authors: Fares Aline Fusco , Maritan Rafael Soleman , Ribeiro Vinicius Fernando , Molina Gabriela Modulo , Barbosa Rafael Teixeira , Imai Victor Jun Ohya , Mota Rafael Augusto Modenez , de Oliveira Joao Victor Moraes , Lopes Julia Belone , Colombo Tatiana Elias , Araujo Daniel Vilarim 
Published: June 2022

e24120

Background: Patients (pts) with cancer are at a higher risk of COVID-19 (C19) severe disease. However, our group and others have demonstrated a low prevalence of C19 infection among asymptomatic pts with cancer on active systemic treatment. We hypothesized this phenomenon was due to increased adherence of pts with cancer to anti-C19 protective measures. This study compares adherence and the perceived importance of such measures in oncologic and non-oncologic populations. Methods: This is a cross-sectional study conducted between June and September 2021. A questionnaire was developed to assess how participants perceived and adhered to masking, handwashing, and other anti-C19 protective measures. Demographic information, educational level, and monthly income were also collected. Three groups were included: A) pts with cancer treated at Hospital de Base (HB); B) pts without cancer treated at HB for other medical conditions; C) a healthy outpatient population. Data were summarized in means, medians, and proportions. Chi-squared or Fisher´s exact test was used to compare categories; ANOVA was employed to compare means. A multivariable analysis assessing factors associated with adherence to anti-C19 protective measures was performed. Results: A total of 607 people were interrogated (200 in groups A and B, and 207 in C). The mean age of groups A, B, C was significantly different: 60 vs. 52 vs. 35 years old (p < 0.001). Group C had a higher educational level and a higher monthly income than groups A and B (p < 0.001). In cohort A, gastrointestinal, breast, and genitourinary were the most frequent tumors (33%, 31%, 15%); 75% of pts had active disease. Pts with cancer were more adherent to anti-C19 protective measures: of 33 points, the mean score of groups A, B, C was respectively 27.8 vs. 25.5 vs. 21.9 (p < 0.001). Regarding the importance of anti-C19 protective measures, pts with cancer also perceived those as more relevant: of 21 points, the mean score of groups A, B, C was respectively 17.8 vs. 17 vs. 16.9 (p < 0.001). For instance, in group A, 95% report consistently wearing a mask when leaving home compared to 90% and 58.2% of groups B and C. In line with our findings, 20.5% vs. 32.5% vs. 35.3% (p < 0.003) of groups A, B, and C reported having C19 before the questionnaire. In multivariable analysis, groups B and C were less likely to adhere to anti-C19 protective measures than group A. Conclusions: Pts with cancer are more adherent to anti-C19 protective measures and perceive them as more important than non-oncologic populations. Our results shed light on the accumulating literature of a low incidence of C19 amongst asymptomatic pts with cancer on systemic treatment even during the surges. Such findings are possibly related to the fact that cancer pts are more vulnerable to hospitalizations and unfavorable outcomes than the general population, prompting a more risk-averse behavior.