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Original research
COVID-19 pandemic stress and cancer symptom burden
  1. Olivia Ballesteros1,
  2. Sueann Mark1,
  3. Astrid Block1,
  4. Lynda Mackin1,
  5. Steven Paul1,
  6. Bruce Cooper1,
  7. Maura Abbott2,
  8. Susan Chang3,
  9. Marilyn J Hammer4,
  10. Jon Levine3,
  11. Rachel Pozzar4,
  12. Karin Snowberg1,
  13. Katy Tsai3,
  14. Erin Van Blarigan5,
  15. Katherine Van Loon3 and
  16. Christine A Miaskowski1
  1. 1Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
  2. 2Department of Nursing, Columbia University Medical Center, New York, New York, USA
  3. 3Department of Medicine, School of Medicine, UCSF, San Francisco, CA, USA
  4. 4Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
  5. 5Department of Epidemiology and Biostatistics, School of Medicine, UCSF, San Francisco, California, USA
  1. Correspondence to Dr Christine A Miaskowski, School of Nursing, UCSF, San Francisco, California 94143, USA; chris.miaskowski{at}ucsf.edu

Abstract

Objectives In a sample of patients with cancer (n=1145) who were assessed during the height of the COVID-19 pandemic, latent profile analysis was used to identify subgroups of patients with distinct stress profiles and to evaluate for differences in demographic and clinical characteristics and symptom severity scores among these subgroups.

Methods Patients completed measures of cancer-specific and COVID-19 stress, global stress, social isolation, loneliness, depression, state and trait anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive function, and pain. Latent profile analysis was used to identify subgroups of patients with distinct stress profiles. Differences among the subgroups in study measures were evaluated using parametric and non-parametric tests.

Results Using clinically meaningful cut-off scores for the stress measures, four distinct stress profiles were identified (ie, none class (51.3%); low stress and moderate loneliness class (24.4%), high stress and moderate loneliness class (14.0%), and very high stress and moderately high loneliness class (high, 10.3%)). Risk factors associated with membership in the high class included: younger age, lower annual household income, lower functional status and higher comorbidity burden. The two worst stress profiles reported clinically meaningful levels of all of the common symptoms associated with cancer and its treatments.

Conclusion Findings from this study, obtained prior to the availability of COVID-19 vaccines and anti-viral medications, provide important ‘benchmark data’ to evaluate for changes in stress and symptom burden in patients with cancer in the postvaccine era and in patients with long COVID-19.

  • Cancer
  • Chronic conditions
  • Psychological care

Data availability statement

Data are available on reasonable request. Data are available on request to the corresponding author after a material transfer agreement is signed with the University of California, San Francisco.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

http://dx.doi.org/10.1136/spcare-2023-004319

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    Data availability statement

    Data are available on reasonable request. Data are available on request to the corresponding author after a material transfer agreement is signed with the University of California, San Francisco.

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    Footnotes

    • Twitter @rpozzar

    • Contributors CAM and KS contributed to the data acquisition. OB, JL, KS and CAM contributed to the study conception and design; analysis of data; and drafted and critically revised the manuscript. BC and SP both contributed to the data analysis and critically revised the manuscript. All of the other authors contributed to the interpretation of the data and critically revised the manuscript. All authors gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy. CAM is responsible for the overall content as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.