Association of fear of COVID-19 with delays in care or treatment interruptions in patients with cancer.
Authors: Smith Karen L. , Caston Nicole E. , Lawhon Valerie , Gallagher Kathleen D. , Angove Rebekah , Anderson Eric , Balch Alan James , Azuero Andres , Huang Chao-Hui , Rocque Gabrielle Betty 
Published: September 2021

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Background: Patients with cancer are at risk for severe COVID-19 and may be vulnerable to health care delays. Delays or interruptions in care may lead to adverse cancer outcomes. Little is known about the relationship between fear of COVID-19 and disruptions in cancer care delivery. Methods: This longitudinal survey was distributed to individuals with cancer who received services July 2019-April 2020 from Patient Advocate Foundation, a non-profit organization that provides case management and financial aid to patients with chronic illness. Data was collected twice - early pandemic (5/20/20-7/11/20) and later pandemic (12/3/20-12/23/20). Fear of COVID-19 was assessed with the Fear of COVID-19 Scale and dichotomized as more (≥22) vs less (< 22) fearful. Respondents reported delays in care or treatment interruptions due to the pandemic and reasons for delays or interruptions. Respondents rated concern about potential long-term health issues due to delays on a 5-point Likert-like scale. We estimated predicted percentages and 95% confidence intervals (CI) using logistic regression models to assess the association of fear of COVID-19 (more vs less fearful) with delay in care or treatment interruption (any vs none) at each time point. We adjusted models for age, sex, race/ethnicity, region, annual household income, marital status, employment status, household size, Area Deprivation Index category, Rural-Urban Commuting Code category, county-level COVID-cases per 100,000, cancer type and number of comorbidities. Results: Amongst the 1,199 early pandemic survey respondents, the majority were female (72%), had household income < $48,000 (73%), and had ≥1 comorbidity (60%). 448 of the early pandemic survey respondents also completed the later survey. 464 (39%) and 166 (37%) respondents were categorized as more fearful at the early and later time points respectively. 567 (47%) and 191 (43%) reported delays or interruptions at the early and later time points respectively. The most common reported reasons for delays or interruptions were hospital/provider restrictions (early: 27%, later: 19%) and patient choice (early: 13%, later: 15%). Among respondents with delays or interruptions at each time point, > 70% were at least moderately concerned about potential long-term health issues due to delays. In adjusted models, more fearful respondents had higher predicted percentages of delayed care or treatment interruptions compared to less fearful respondents early (more fearful: 56%, 95% CI 39%-72%; less fearful: 44%; 95% CI 28%-61%) and later (more fearful: 55%, 95% CI 35%-73%; less fearful: 38%; 95% CI 22%-57%) in the pandemic. Conclusions: Fear of COVID-19 is common among patients with cancer and is linked with delays in care and treatment interruptions. System-wide strategies are needed to address fear of COVID-19 and to ensure equitable, timely, and safe access to cancer care throughout the pandemic.