Journal Article

HIGHER LEVELS OF STRESS CONTRIBUTE TO A WORSE SYMPTOM PROFILE IN PATIENTS WITH CANCER DURING THE COVID-19 PANDEMIC

Cohen, Bevin, Abbott, Maura, Miaskowski, Christine, Hammer, Marilyn

2024

Overview

Beyond the stress of a cancer diagnosis, stressors associated with a global pandemic (loneliness, social isolation, financial toxicity) may exacerbate patients' symptom experiences. No studies have examined these relationships using a comprehensive symptom inventory and measures of four different types of stress. The purpose was to identify distinct symptom profiles and evaluate for differences among the profiles in demographic and clinical characteristics and stress. Data were collected from 1144 patients from May 2020 and February 2021 via an online survey. Patients completed an online questionnaire that included: revised Memorial Symptom Assessment Scale (37 symptoms), Impact of Event Scale-Revised (GOVID-19 and cancer-specific stress), Perceived Stress Scale (global stress), Social Isolation Scale, UCLA Loneliness Scale, and Comprehensive Score for Financial Toxicity. Using symptom occurrence rates, latent class analysis was done to identify distinct symptom profiles. Differences among the profiles were evaluated using parametric and non-parametric tests. Four distinct profiles were identified (Le., Low (28.2%), Moderate Physical and Lower Psychological (22.7%), Moderate Physical and Higher Psychological (31.6%), and High (17.4%); Figure 1). Mean number of symptoms was 3.5 (+2.0) and 19.0 (+3.5) in Low and High classes, respectively. Compared to the Low class, patients in the High class were younger, more likely to be female, had a lower level of education, and a lower annual income. In addition, patients in the High class had a higher body mass index, a worse comorbidity profile, a lower functional status, and were more likely to be receiving active treatment. As the symptom profiles worsened, levels of global stress, COVID-19 and cancer-specific stress, loneliness, and financial toxicity increased in a dose response fashion (i.e., Low < Moderate Physical and Lower Psychological < Moderate Physical and Higher Psychological < High). Patients in the High class had stress scores suggestive of post-traumatic stress disorder, moderate to moderately high level of loneliness, and significant financial toxicity. Distinct symptom profiles identified in this study are consistent with a previous report of patients receiving chemotherapy. While recovery from the GOVID-19 pandemic is occurring, these findings provide \"baseline\" data to use for comparative purposes. These findings provide strong support for an association between increasing symptom burden and higher levels of multiple types of stress. Clinicians need to perform comprehensive assessments of both symptom burden and stress to provide tailored interventions.

• Publisher: Oncology Nursing Society
• Subject: Cancer / Chemotherapy / COVID-19 / Loneliness / Oncology / Pandemics / Post traumatic stress disorder / Social isolation / Symptom management / Toxicity