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How are older cancer survivors coping amid the COVID-19 pandemic: A mixed-methods study

Study Lead
Study Lead
Assistant Professor
Ziwei Liu
Kristen Haase, Assistant Professor, School of Nursing, Faculty of Applied Science, The University of British Columbia
Shaila Merchant, MD, Assistant Professor, Queen’s University; Surgical Oncologist, Kingston Health Sciences Centre
Danielle Kain, MD, Assistant Professor, School of Medicine, Queen’s University; Palliative care physician, Kingston Health Science Centre
Michael Brundage, MSc, FRCPC, MD, Department of Oncology, Queen's University; Radiation Oncologist, Kingston Regional Cancer Centre
Christopher Booth, MD, FRCPC; Departments of Oncology and Medicine, Queen's University; Medical Oncologist, Clinician-Scientist, Cancer Centre of Southeastern Ontario

What? Cancer patients over 65 years of age are among the most vulnerable populations to the  harmful effects of COVID-19. Given that nearly 9 out of 10 cancer diagnoses occur among people 60 years of age and older, older persons affected by cancer are an important group to study during this pandemic. Despite completing treatment, cancer survivors still need psychosocial care and follow-up to support their recovery, particularly during the first year after treatment. However, given the physical distancing measures associated with COVID-19, access to many in-person cancer-related resources is reduced or no longer available. This may be especially problematic for older cancer survivors who have been recently (≤ 12 months) discharged from cancer centre.

In this study, we explore: 1) how the COVID-19 pandemic affects older survivors’ access to formerly used and/or desired resources; 2) what resources they use to cope with their cancer-related concerns during the pandemic; 3) how these resources help (or not) to meet their cancer-related needs; and 4) their ideas for suitable resources and delivery methods when traditionally offered health care resources are not available.

Why? In our former research (Spring 2020), some cancer survivors expressed heightened anxiety and fear related to the COVID-19 pandemic. These perspectives, and the reduced availability and access to many oncology resources, could compound the negative impact of the pandemic for older cancer survivors recently discharged from cancer centre (≤ 12 months). Therefore, we aim to advance our understanding about how these cancer survivors cope with their cancer-related resources during COVID-19 pandemic.

How? This study employed both qualitative and quantitative research in a mixed method design. Invited participants were purposefully selected from a pool of cancer survivors willing to be contacted by our team for further research. The qualitative portion of the study involved a 1:1 telephone interview, which explored participants’ perceptions, emotions and behaviours in response to being an older cancer survivor during COVID-19. For the quantitative portion of the study, participants completed the Brief-COPE questionnaire designed to assess 14 coping responses used to cope with life stressors. Participants consented to have their demographic and clinical data extracted from that collected as part of our former research.

Findings: Participants reported  using a variety of strategies that – overall – were helpful for them to cope with their health-related concerns during the pandemic. They drew upon their lived experiences from work, life, and illness, applying them to the global health crisis. In summary, participants reported struggling with ongoing virtual appointment -which they were willing to do but did not prefer. They also felt that visitor policies were restrictive as they continued to cope with ongoing symptoms and concerns about recurrence. As well, the loss of socialization was isolating and negatively impacted their overall well being. 

To alleviate their concerns, patients had four recommendations for future care delivery, when traditionally offered cancer-related resources aren't available: 

  • For patients to received enhanced baseline information from their care team (e.g., a written summary of follow-up visits, symptoms to watch for and who to call)
  • For health providers to facilitate caregiver support and engagement (e.g., consider how support person can attend appointments), and promote supportive resources (e.g., peer support).
  • For health providers to integrate technology for varying aspects of follow-up care
  • For patients and the general public to sustain the use of personal protective equipment when feeling unwell so as to protect the public

Impact of findingsThe results of this study will be useful to understand the cancer-related needs and coping strategies used by survivors during the COVID-19 pandemic. Results could be used to inform post-pandemic cancer care and the development of supportive resources for cancer survivors.

Funded By
Queen’s University SARS CoV‐2/COVID‐19 grant