Assessing Patient Risk from Cancer and COVID-19: Managing Patient Distress

Klaassen, Zachary; Wallis, Christopher J.D.

BACKGROUND: The rapid spread of Coronavirus Disease 2019 (COVID-19) beginning in Spring 2020 necessitated significant changes to day-to-day interactions in society, as well as to the practice of medicine. Particularly in patients with cancer, these changes can exacerbate the pre-existing psychological stress associated with cancer diagnosis and treatment. METHODS: We performed a narrative review, encompassing changes to cancer care as a result of COVID-19, the psychological effects of treatment delays, and strategies to mitigate these effects. RESULTS: A number of review articles and guideline bodies have provided guidance on patients for whom treatment may be safely delayed, including low-risk bladder, prostate and kidney tumors, as well as intermediate and high-risk prostate cancer. Mental health diagnoses are prevalent in patients with genitourinary malignancies. Evidence regarding psychologic effects of deferred treatment is limited to those with low risk of disease related morbidity. In this population, psychologic distress attenuated with time. However, in the COVID-19 context, patients with advanced disease are particularly prone to psychologic distress, as are women and younger patients. Strategies to mitigate this distress are emerging and center on recognition from the treating oncologist with appropriate referral as necessary to psycho-oncology providers and engagement of peer-supports. CONCLUSIONS: The COVID-19 pandemic has reshaped social structures and health care delivery. For patients with genitourinary malignancies, this may be associated with significant distress, particularly among those with advanced disease and those undergoing active treatment. Physicians treating these patients need to be aware of the psychologic stress the combined effects of the COVID-19 pandemic, cancer diagnosis, and cancer treatment can have and make appropriate referrals to support the holistic care of their patients.