Impact of the COVID-19 Pandemic on Quality of Life for Women with Ovarian Cancer

Frey, Melissa K.; Ellis, Annie E.; Zeligs, Kristen; Chapman-Davis, Eloise; Thomas, Charlene; Christos, Paul J.; Kolev, Valentin; Prasad-Hayes, Monica; Cohen, Samantha; Holcomb, Kevin; Blank, Stephanie V.

Abstract Purpose The COVID-19 pandemic has resulted in unprecedented challenges for the oncology community. For people living with cancer, treatments are interrupted, surgeries cancelled and regular oncology evaluations rescheduled. People with cancer and their physicians must balance plausible fears of COVID-19 and cancer treatment with the consequences of delaying cancer care. We aim to evaluate the experience of women with ovarian cancer during the COVID-19 pandemic. Methods Women with a current or prior diagnosis of ovarian cancer completed an online survey focusing on treatment interruptions and quality of life (QOL). QOL was measured with the Cancer Worry Scale and Hospital Anxiety and Depression Scale. The survey was distributed through survivor networks and social media. Univariate and multivariable linear regression analysis were utilized to evaluate the effect of participant characteristics on QOL survey scores. Results Six hundred and three women, from 41 states, visited the survey website between March 30 and April 13, 2020 and 555 (92.0%) completed the survey. The median age was 58 years (range 20-85). Two hundred and seventeen participants (43.3%) were in active treatment at the time of survey completion. One hundred and seventy-five participants (33%) experienced a delay in some component of their cancer care. Ten (26.3%) of the 38 participants scheduled for surgery experienced a delay and 18 (8.3%) of the 217 participants scheuled for nonsurgical cancer treatment. One hundred and thirty-three participants (24.0%) had a delayed physician appointment, 84 (15.1%) laboratory test and 53 (9.6%) cancer related imaging. Among the cohort, 88.6% (489) reported significant cancer worry, 51.4% (285) borderline or abnormal anxiety and 26.5% (147) borderline or abnormal depression. On univariate analysis, age less than 65 years, being scheduled for cancer treatment or cancer surgery, delay in oncology care, self-described as immunocompromised and use of telemedicine were all associated with higher levels of cancer worry. Higher anxiety scores were associated with age less than 65 years and self-described as immunocompromised. Higher depression scores were associated with age less than 65 years, being scheduled for cancer surgery, delay in oncology care, self-described as immunocompromised and use of telemedicine. On multivariable linear regression analysis, age less than 65 and being self-described as immunocompromised were independently predictive of greater cancer worry, anxiety and depression and delay in cancer care was predictive of anxiety and depression. Conclusions The COVID-19 crisis is impacting care of ovarian cancer patients: surgeries, treatments, scheduled physician appointments, laboratory tests and imaging are cancelled or delayed. Younger age, presumed immunocompromise and delay in cancer care were associated with significantly higher levels of cancer worry, anxiety and depression. Providers must work with patients to balance competing risks of COVID-19 and cancer, recognizing that communication is a critical clinical tool to improve quality of life in these times.