key: cord-0800005-xwljhfk8 authors: Chen, Gaili; Wu, Qiuji; Jiang, Huangang; Zhang, Hongyan; Peng, Jin; Hu, Jing; Chen, Min; Zhong, Yahua; Xie, Conghua title: Fear of disease progression and psychological stress in cancer patients under the outbreak of COVID‐19 date: 2020-07-14 journal: Psychooncology DOI: 10.1002/pon.5451 sha: 130e004480a647923176b051697cf20dcb9dd8e2 doc_id: 800005 cord_uid: xwljhfk8 nan Univariate analysis revealed that educational level (P < .001), income (P < .001), cancer diagnosis (P < .001), deep concern about COVID-19 • There is a very high prevalence of fear of disease progression, anxiety, and depression in cancer patients under the outbreak of COVID-19. • Of all 326 respondents, 282 (86.5%) patients reported fear of disease progression, 220 (67.5%) anxiety, and 243 (74.5%) depression. • Multiple linear regression revealed that treatment delay or interruption, deep concern about COVID-19, lung cancer, lower educational level, or income were the dominant factors contributing to such prevalence. • Organization and management for psychological interventions in China were imperfect. • Appropriate and personalized psychological intervention is in urgent need and should be formulated for cancer patients. (P < .001), and treatment disturbance (P < .001) were associated with FoP-Q-SF scores. Gender (P = .04), educational level (P < .001), income (P = .017), cancer diagnosis (P < .001), deep concern about COVID-19 (P < .001), and treatment disturbance (P < .001) were associated with SAS scores. Marriage status (P = .018), educational level (P < .001), cancer diagnosis (P < .001), deep concern about COVID-19 (P < .001), and treatment disturbance (P < .001) were associated with SDS scores (Table 1) . Multiple linear regression analysis revealed that FoP-Q-SF scores were positively correlated with treatment delay (P = .001), treatment interruption (P = .001), deep concern about COVID-19 (P < .001), and lung cancer diagnosis (P = .020). SAS scores were positively correlated with treatment delay (P < .001), treatment interruption (P < .001), deep concern about COVID-19 (P < .001), and lung cancer diagnosis (P = .009), and it negatively correlated with education level (P = .001). SDS scores were positively correlated with treatment delay (P < .001), treatment interruption (P < .001), deep concern about COVID-19 (P = .028), and unmarried status (P = .025), and it negatively correlated with higher income (P = .023) (Figure 1 ). Abbreviations: FoP-Q-SF, Fear of Progression Questionnaire-Short Form; SAS, Self-Rating Anxiety Scale, SDS, Self-Rating Depression Scale. In this survey study, we demonstrated that there was a high prevalence of fear of disease progression, anxiety, and depression in cancer patients under the outbreak of COVID-19, which was much higher than results obtained from general populations (16.5% reported depression and 28.8% reported anxiety) 7 and cancer patients in times without an epidemic (anxiety in 10% of cancer patients, and depression in 20%). 8 Treatment delay or interruption, deep concern about COVID-19, and lung cancer were the dominant factors contributing to such prevalence. Significant influence of treatment disturbance on psychological stress may reflect that oncologists did not have adequate information to address the sense of uncertainty due to treatment interruption. Imperfect organization for psychological interventions was another issue of concern. 6 Under the outbreak of COVID-19, psychosocial clinicians were restricted from the clinics, oncologists became the main personnel providing varied psychological interventions to cancer patients. Poor recognition of depression and anxiety was shown to be associated with impaired survival in cancer patients. 8, 9 And cancer patients receiving early psychological interventions had less aggressive care at the end of life and longer survival. 10 Therefore, appropriate and personalized psychological intervention is in urgent need and should be formulated for cancer patients. Limitations existed in this study: First, the questionnaire was not randomly distributed but only to patients with integrated comprehensive competence; therefore, the results might not depict the overall scenario of the whole patient population. Second, self-reported results of the survey might not always be able to reflect authentic levels of psychological impact in cancer patients. Last but not least, the sample size was relatively small. Nevertheless, to our knowledge, this is the first study that surveyed fear of disease progression, anxiety, and depression in cancer patients in the epicenter of the COVID-19 epidemic. Our findings would be valuable in that it provided information on the prevalence of psychological disorders and deciphering associated risk factors, which in turn could help identify vulnerable patients and deliver personalized interventions and treatments. This work was supported by the National Natural Science Foundation of China (81602164, 81803061). The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. https://orcid.org/0000-0003-1459-691X 2019-nCoV epidemic: address mental health care to empower society SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan Mental health care for medical staff in China during the COVID-19 outbreak Psychological interventions for people affected by the COVID-19 epidemic Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China Depression and anxiety in patients with cancer Impact of fear of cancer recurrence on survival among lymphoma patients Early palliative care for patients with metastatic non-small-cell lung cancer