Impact of stopping therapy during the SARS-CoV-2 pandemic in persons with lymphoma
Abstract
Introduction
The severe acute respiratory syndrome-2 (SARS-CoV-2) pandemic disrupted medical care for persons with cancer including those with lymphoma. Many professional societies recommend postponing, decreasing or stopping anti-cancer therapy in selected persons during the pandemic. However, although seemingly sensible these recommendations are not evidence-based and their impact on anxiety and health-relatedquality-of-life(HRQoL) is unknown.
Methods
Surveyed 2532 subjects including 1060 persons with lymphoma, 948 caregivers and 524 normal, uninvolved persons using a purposed-designed questionnaire on a patient organization website. Respondents also completed the Zung Self-Rating Anxiety and patient respondents, the EORTC QLQ-C30 instruments to quantify anxiety and HRQoL. We also evaluated caregiver support and an online education programme of the Chinese Society of Clinical Oncology (CSCO). Data of HRQoL from a 2019 pre-pandemic online survey of 1106 persons with lymphoma was a control.
Results
33% (95% Confidence Interval [CI] 30, 36%) of lymphoma patients and 31% (28, 34%) of caregivers but only 21% (17, 24%) of normal individuals had any level of anxiety (both pair-wiseP< 0.001). Amongst lymphoma respondents physical exercise and better caregiver support were associated with less anxiety whereas female sex, receiving therapy and reduced therapy intensity were associated with more anxiety. Paradoxically, lymphoma respondents during the pandemic had better HRQoL than pre-pandemic controls. Reduced therapy intensity was associated with worse HRQoL whereas respondents who scored caregiver support and the online patient education programme high had better HRQoL.
Conclusions
During the SARS-CoV-2 pandemic lymphoma patients and their caregivers had significantly higher incidence of anxiety compared with normals. Lymphoma respondents reported better HRQoL compared with pre-pandemic controls. Reduced therapy-intensity in patients with cancer may have unanticipated adverse effects on anxiety and HRQoL. Regular and intense support by caregivers and online education programmes alleviate anxiety and improve HRQoL.
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