Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov;60(5):e25-e34.
doi: 10.1016/j.jpainsymman.2020.08.037. Epub 2020 Sep 2.

Stress and Symptom Burden in Oncology Patients During the COVID-19 Pandemic

Christine Miaskowski  1 , Steven M Paul  2 , Karin Snowberg  2 , Maura Abbott  3 , Hala Borno  4 , Susan Chang  4 , Lee M Chen  4 , Bevin Cohen  5 , Marilyn J Hammer  6 , Stacey A Kenfield  4 , Kord M Kober  2 , Jon D Levine  4 , Rachel Pozzar  6 , Kim F Rhoads  4 , Erin L Van Blarigan  4 , Katherine Van Loon  4
Affiliations

Stress and Symptom Burden in Oncology Patients During the COVID-19 Pandemic

Christine Miaskowski et al. J Pain Symptom Manage. 2020 Nov.

Abstract

Context: No information is available on oncology patients' level of stress and symptom burden during the coronavirus disease 2019 (COVID-19) pandemic.

Objectives: To evaluate for differences in demographic and clinical characteristics, levels of social isolation and loneliness, and the occurrence and severity of common symptoms between oncology patients with low vs. high levels of COVID-19 and cancer-related stress. In addition, to determine which of these characteristics were associated with membership in the high-stressed group.

Methods: Patients were 18 years and older; had a diagnosis of cancer; and were able to complete an online survey.

Results: Of the 187 patients in this study, 31.6% were categorized in the stressed group (Impact of Event Scale-Revised [score of ≥24]). Stressed group's Impact of Event Scale-Revised score exceeds previous benchmarks in oncology patients and equates with probable post-traumatic stress disorder. In this stressed group, patients reported occurrence rates for depression (71.2%), anxiety (78.0%), sleep disturbance (78.0%), evening fatigue (55.9%), cognitive impairment (91.5%), and pain (75.9%). Symptom severity scores equate with clinically meaningful levels for each symptom.

Conclusion: We identified alarmingly high rates of stress and an extraordinarily high symptom burden among patients with cancer, exceeding those previously benchmarked in this population and on par with noncancer patients with post-traumatic stress disorder. Given that the COVID-19 pandemic will likely impact cancer care for an indefinite period, clinicians must exhibit increased vigilance in their assessments of patients' level of stress and symptom burden. Moreover, an increase in referrals to appropriate supportive care resources must be prioritized for high-risk patients.

Keywords: COVID-19; Symptoms; cancer; loneliness; social isolation; stress.

PubMed Disclaimer

Comment in

  • Pandemic Uncertainty.
    Lyon D. Lyon D. Oncol Nurs Forum. 2020 Nov 1;47(6):621-622. doi: 10.1188/20.ONF.621-622. Oncol Nurs Forum. 2020. PMID: 33063776

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Cordova M.J., Riba M.B., Spiegel D. Post-traumatic stress disorder and cancer. Lancet Psychiatry. 2017;4:330–338. - PMC - PubMed
    1. Weber D., O'Brien K. Cancer and cancer-related fatigue and the interrelationships with depression, stress, and inflammation. J Evid Based Complement Altern Med. 2017;22:502–512. - PMC - PubMed
    1. Picaza Gorrochategi M., Eiguren Munitis A., Dosil Santamaria M., Ozamiz Etxebarria N. Stress, anxiety, and depression in people aged over 60 in the COVID-19 outbreak in a sample collected in Northern Spain. Am J Geriatr Psychiatry. 2020;28:993–998. - PMC - PubMed
    1. Cortes-Alvarez N.Y., Pineiro-Lamas R., Vuelvas-Olmos C.R. Psychological effects and associated factors of COVID-19 in a Mexican sample. Disaster Med Public Health Prep. 2020:1–12. - PMC - PubMed
    1. Serafini G., Parmigiani B., Amerio A. The psychological impact of COVID-19 on the mental health in the general population. QJM. 2020;113:531–537. - PMC - PubMed