Cancer survivors often develop an ability to adapt to the challenges that come with a life-threatening illness, which may benefit them when facing challenges in other areas of life. A new study from the University of Chicago Medicine finds high rates of resilience in ovarian cancer survivors during the first few months of the COVID-19 pandemic.
But as the pandemic continues, the mental health of these patients may be at long-term risk. This study found high rates of loneliness, which the authors warned could erode flexibility. The authors suggest that incorporating more mental health services into cancer care is a possible solution.
Melissa Gavilana, MD, a clinical fellow in the Division of Gynecological Oncology, is first author of the report, which was published in February in JCO Oncology Practice. For the study, Gavilana and her co-authors conducted a telephone survey during May and June 2020. They interviewed 61 advanced-stage ovarian cancer survivors treated at UChicago Medicine, including survivors who were in remission as well as those receiving treatment . to repeat.
Gavilana and her team, including lead author Nita K. Lee, MD, MPH, associate professor of obstetrics and gynecology, adapted the questions asked in the survey from a larger survey about the effects of COVID-19 on women’s mental health.
Working from home while asking to stay at home, they designed survey questions tailored to ovarian cancer residents and contacted respondents by phone. Respondents were asked about many traits of their mental health — including anxiety, depression, loneliness, resilience, and health-related quality of life — as well as questions about cancer treatment and the experience of the pandemic.
Resilience was assessed through questions about how respondents coped with difficult or stressful events, and how long recovery took them after. Survey results showed that 90% of respondents reported normal or high resilience, and those who described their resilience as high had a healthier quality of life.
Notably, only 2% of respondents reported depression and 4% reported moderate or severe anxiety. These results were somewhat surprising because previous studies of ovarian cancer patients showed higher rates of anxiety and depression (more than 20% for anxiety and more than 15% for depression).
Maintaining quality of life during COVID-19
Gavilana was encouraged that resilience was prevalent in these patients and that rates of anxiety and depression were low. However, she is concerned about whether these patients have been able to maintain their resilience since the early days of the epidemic when the survey was conducted. “One of the big things I wonder about is whether these people have lost resilience through all of this. We called people three or four months into the pandemic, and now two years later, have they been able to adapt to it and maintain their resilience? Or is it that This ongoing epidemic has weakened them? Who was able to maintain their resilience and who couldn’t?”
43% of study participants reported feeling lonelier than they did before the pandemic began. Although this finding is not surprising, it is concerning because loneliness is linked to a variety of health issues, and it can compromise resilience.
Because of their precancerous condition and in some cases, their advanced age, many ovarian cancer patients have had difficulty seeing family members throughout the pandemic. Gavilana has treated patients who still fear traveling, and others whose families were worried about coming to see them, even after vaccinations became available.
“A lot of them said, ‘I’d rather take a risk,'” she said, “but the people around me don’t want to risk my health.”
While the main goal of cancer treatment is to extend patients’ lives, Gavilana advocates prioritizing quality of life as well.
“It’s not worth continuing to have chemotherapy if all you can do after that is lie in bed feeling sick, or sit in your house when you’re not able to enjoy your life and enjoy the people you love,” Gavilana said. “People are more than sick, and the reason we treat this disease is to give people a good time. We have to remember to keep the focus on that.”
Meeting the mental health needs of cancer patients
Working first as a resident and now as a fellow in gynecological oncology, Javelana has developed insight into the needs of cancer patients throughout their treatment. She notes that this area of medicine is prone to burnout, especially when it comes to mental health.
“Gynecological oncology is pretty much a do-it-yourself specialty, doing both surgery and chemotherapy, and then longitudinal follow-up of these patients to monitor for cancer. We want to support these patients with the heavy mental health burden they carry, but when the pressure is On the system with something like COVID-19, mental health care is often the first thing that ends up on the side of the road.”
UChicago Medicine provides mental health services to patients with cancer through its Supportive Oncology Program, including the Psychological Oncology Program. Patients are evaluated for signs of psychological distress and communicate with psychologists, psychiatrists, and social workers who support them and their families through their treatment.
The Department of Gynecological Oncology leads community programs with local and national cancer advocacy groups to provide additional support options for patients and caregivers. Since the pandemic, many have included online and virtual resources, which have helped many stay connected but have limitations for older patients or those without technical support. Gavilana said more should be done to make these services available to patients who need them.
“We have great mental health providers at UChicago Medicine, but there aren’t enough of them,” she said. “The big problem in this area is the inability to connect patients with mental healthcare professionals who can help them.
“This study provides more evidence that we need more integrated mental health providers in cancer care in general, especially for types of cancer that have a high mortality rate such as ovarian cancer, but also lung cancer among others,” Gavilana said. “These patients need more support to help them deal with these difficult diagnoses.”
Additional authors of the study, “Pandemic Resilience: Impact of COVID-19 on Psychopathy and Health-Related Quality of Life among Women with Ovarian Cancer,” include Faye J. Hluboki, MA, PhD, Sahana Somasegar, MD, Mia Sorkin, MSS, PA- C, Katherine C., MPH, from the University of Chicago.
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