Multi-institutional survey of COVID-19 impact in cancer care in patients and health care providers
Authors: Sylvia V. Alarcon, Omid Salehi, Eduardo A. Vega, Vera Kazakova, Claudius Conrad
Journal: Clinical Cancer Research (2020)

Background: The COVID-19 pandemic has altered the priorities and capacities of health care systems worldwide, including how oncologic care is managed  Unprecedented changes to cancer care are being implemented to reducerates of infection and conserve health care resources, while providing optimal cancer care  To this date, nocomprehensive study has been conducted to assess the attitudes of both oncology patients and providerssurrounding these changes  Methods: A multi-institutional survey was provided to patients and oncology health care professionals Demographics and clinical data were collected  Questions concerning treatment, safety, communication, andemotional stress before and after the pandemic outbreak was measured on a 5-point Likert scale  Open-endedresponses were collected, scored in a blinded fashion by three providers, and evaluated using Nominal GroupTechnique  Wilcoxon signed-rank test and Wilcoxon rank-sum test were used to compare provider and patientanswers where appropriate  Results: Patient concerns regarding susceptibility to infection [z=2 536, p=0 011] and their cancer outcome[z=4 572, p<0 001] were significantly increased during the COVID-19 period  Factors associated with increasedconcern were colorectal cancer, white race, stage 3 and 4, active treatment, and <1 year since diagnosis  However, providers were more concerned regarding outcome than patients, believing that cancer care is overall more poorlyplanned [z=-3 857, p=<0 001]  While patients were comparatively more worried about contracting COVID-19 thanproviders, providers felt less safe in clinic  Nonetheless, providers had more concern about patients contractinginfection than patients themselves, felt facilities were less sanitary, and had less confidence in the hospital overall Among providers, strong concerns regarding availability of protective personal equipment [z=-4 082, p<0 001] andinfecting providers' families [z=4 965, p<0 001] were identified  Further, providers (significantly more than patients)felt that cancer care planning and communication were worse than before COVID-19  Conclusion: To our knowledge, this is the first multi-institutional survey to assess the impact of the COVID-19pandemic on patients and providers  Patients had more difficulty coping during the pandemic, suggesting anincreased need for emotional support  Nonetheless, patients did not perceive significant differences in their cancertreatment  This is in stark contrast to providers, who had major concerns regarding their ability to provide optimalcancer care, felt unprepared to handle the outbreak independent of the practice setting, and had personal safetyconcerns  This study suggests that more emotional support infrastructure for patients is required  Further, the bleakassessment of providers regarding effectiveness of their treatment and concerns for their personal safety raisesconcern for an increased risk of provider burnout, suggesting the need for novel targeted interventions