Impact of the Covid-19 Pandemic on Quality of Life of Patients with CML
Authors: Wysoglad Hubert , Szczepanek Elzbieta , Chukwu Ositadima , Lebowa Weronika , Nowak Wiktor , Sacha Tomasz 
Published: November 2021

Abstract
Introduction
Introduction of imatinib and other tyrosine kinase inhibitors (TKIs) dramatically improved the quality of life (QoL) of patients with chronic myeloid leukemia (CML). However, the impact of Covid-19 on the QoL of patients with CML has not been measured so far. We aimed to investigate the QoL of CML patients during the Covid-19 pandemic, with a special focus on their personal beliefs on the pandemic, vaccinations, changes in their functioning and experience with the health service at this time.
Methods
Due to social distancing measures, we conducted a survey with 29 CML patients via the internet and telephone interview. 10 patients were female, 19 were male. The median age was 54. Responses were collected during and after the third wave of the SARS-COV-2 pandemic in Poland between 24 th March 2021 and 18 th July 2021.
The survey was divided into three sections. Section 1 assessed patients' opinions on the pandemic, social distancing measures, and access to the health care system during the pandemic, as well as the impact of existing restrictions on their QoL. Section 2 assessed opinions on the functioning of the health care system during the pandemic, and the effect on transportation means to health care centers. Here, patients could choose more than one statement that best applied to the existing situation. Section 3 assessed patients' attitudes towards vaccinations against the influenza virus and SARS-COV-2 and their preferences for the type of vaccination.
Results
72% of patients agreed that Covid-19 is a significant threat and disagreed that restrictions imposed during the pandemic were too severe. 69% commonly agreed that other people did not adequately obey social distancing measures while assessing that they comply with the existing guidelines (83%).
55% of patients agreed that the pandemic had a significantly negative impact on their QoL. 72% reported not losing control of CML during the pandemic, and nearly all (93%) stated that the pandemic did not impact their adherence to treatment with TKIs.
In Section 2, the most commonly reported health care problem during the pandemic was long waiting times for medical consultations (19 replies). Difficulty with access to the lead physician and complicated, unclear procedures with hospital admission were also reported frequently (15 and 14 replies, respectively).
40% of patients were forced to change their means of transportation to healthcare facilities from public transport to a personal vehicle.
In the last five years, only 34% of patients in the cohort received a vaccine against the influenza virus. Of these, 42% claimed this was due to medical personnel's inadequate information, and 37% deemed the influenza vaccine to be ineffective. 66% of patients reported to have already received the Covid-19 vaccination (45% patients had received two doses, 21% received one dose); 21% of patients did not receive the vaccination but reported that they intended to, and 14% (4 patients) of patients reported that they do not want to receive the vaccination against the SARS-COV-2 virus. Of these, 3 considered the vaccines insufficiently tested in clinical trials; 2 explained that they have contraindications to the vaccinations, and 1 patient was afraid of adverse effects related to the vaccinations. 2 of these patients had university-level degrees, 1 had a high school diploma, and 1 received vocational education. 2 lived in towns with &lt; 20 thousand inhabitants, 1 in a city of 20-50 thousand inhabitants and 1 in a city of 50-100.000 inhabitants. 3 were female, 1 was male.
When asked to determine which Covid-19 vaccination they would prefer, had they been given a choice, 80% picked the Pfizer-Biontech vaccine, 8% the Johnson and Johnson vaccine, 4% the Moderna vaccine, 4% the Sputnik vaccine, and 4% claimed that the type of vaccine did not make a difference. 0% chose the Astra-Zeneca vaccine.
Limitations
A limitation of our study is the small cohort of patients. A larger group of patients could help provide a more accurate measurement of patients' opinions. Yet, given the lack of previous reports, this is a good foundation for the future.
Conclusions
The Covid-19 pandemic has negatively impacted the QoL and access to healthcare for CML patients, although it did not impact adherence to treatment. Most patients were vaccinated against Covid-19 or prepared to receive the vaccine. More attention and time needs to be given to patients' education regarding vaccinations in the future.
Figure 1 Figure 1.

Disclosures
Sacha: Roche: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Bristol-Myers Squibb: Honoraria, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau; Angelini: Honoraria, Speakers Bureau.