Patients with cancer experienced symptoms of post-traumatic stress disorder (PTSD) during the first year of the COVID-19 pandemic, according to a study published in the Journal of the National Comprehensive Cancer Network.
Researchers evaluated post-traumatic stress symptoms (PTSS) among cancer patients during the lockdown and release periods that took place in France between April 2020 and May 2021.
The team found that 21.5% of patients had moderate to severe PTSS during the first lockdown, the proportion of patients with PTSS fluctuated over time, and 17.5% of patients had PTSS at last follow-up.
This trial (COVIPACT; ClinicalTrials.gov Identifier: NCT04366154) enrolled adults who were receiving outpatient treatment for solid tumors or hematologic malignancies at 2 cancer centers in France during the first nationwide lockdown.
Patients completed the Impact of Event Scale–Revised (IES-R), a 22-item questionnaire that highlights avoidance, intrusion, and hyperarousal PTSS in relation to a prespecified stressful event.
The questionnaire was completed at various points of lockdown and release in France:
- M0 was the first lockdown in April and May 2020
- M3 was during the first release period in July and August 2020
- M6 was during the second lockdown in October and November 2020
- M9 was after the second release in January and February 2021
- M12 was during the third lockdown in April and May 2021.
There were 386 patients who completed the IES-R at baseline and at least 1 follow-up assessment. The patients’ median age was 63 (range, 28-87) years, and most were women (76%). Cancer types included breast cancer (50%), urologic and gynecologic cancers (18%), lung/head and neck cancers (17%), digestive cancers (11%), and other cancers, including hematologic cancers (4%). About half of the cohort had metastatic disease (54%).
The proportion of patients with PTSS changed significantly over time (P <.001). It was:
- 21.5% during the first lockdown (M0)
- 13.6% during the first lockdown release (M3)
- 23.2% during the second lockdown (M6)
- 22.7% after the second lockdown (M9)
- 17.5% during the third lockdown (M12).
“All 3 PTSD components (avoidance, intrusion, and hyperarousal) followed a similar trajectory over time,” the researchers noted.
There were several groups of patients who had more PTSS at baseline, including women, patients who felt socially isolated during the first lockdown, those who had fears of getting COVID-19, and patients who reported increased use of psychotropic drugs during the study period. The researchers noted that these associations “remained broadly constant over time.”
Another group with more PTSS at baseline was patients who experienced any adjustment in medical oncology practices during the first lockdown. However, PTSS decreased over time in this group, and there was no difference after the release period in July and August 2020 (M3).
“Overall, we identified approximately one-fourth of patients with cancer with persistent PTSS over the first year of the COVID-19 pandemic,” the researchers wrote. “Long-term follow-up studies should shed light on the consequences of such psychological distress, especially in the field of oncology, where distress is correlated with poor adherence to treatment and survival.”
The researchers noted that the COVIPACT 2 trial (ClinicalTrials.gov Identifier: NCT04747249) is underway. This trial includes patients from COVIPACT with a moderate to severe level of PTSS, and the goal is to evaluate the benefit of psychological interventions to reduce PTSS in these patients.
Bastien E, Lefevre-Arbogast S, Lequesne J, et al. Posttraumatic stress symptoms in patients with cancer during the COVID-19 Pandemic: A one-year longitudinal study. J Natl Compr Canc Netw. Published online February 22, 2023. doi:10.6004/jnccn.2023.7085.