Mental Health and Adherence to COVID-19 Protective Behaviors among Cancer Patients during the COVID-19 Pandemic: An International, Multinational Cross-Sectional Study

SIMPLE SUMMARY: Whilst information on the impact of COVID-19 on cancer care continues to increase exponentially, little is known about the impact of COVID-19 on the mental health and coping behaviors of cancer patients. This study constitutes a sub-study of a large international survey conducted during the first wave of the pandemic, looking specifically at the impact of COVID-19 on the mental health and protective behaviors of cancer participants, compared to non-cancer participants. It also explored whether cancer participants perceived COVID-19 as a bigger threat compared to their cancer and whether this perception affected their psychological outcomes, such as their perceived level of stress. Overall, cancer participants appeared better adapted compared to non-cancer participants, well-functioning, resilient and able to adjust, and prepared to deal with what is otherwise a worldwide crisis; perhaps as a result of their previous cancer experience. Whilst good news, these results should not lead to a dismissal of the specific needs of cancer patients and as the pandemic drags on, cancer population dedicated studies should be performed to ensure adequate care for these patients. ABSTRACT: A population-based cross-sectional study was conducted during the first COVID-19 wave, to examine the impact of COVID-19 on mental health using an anonymous online survey, enrolling 9565 individuals in 78 countries. The current sub-study examined the impact of the pandemic and the associated lockdown measures on the mental health, and protective behaviors of cancer patients in comparison to non-cancer participants. Furthermore, 264 participants from 30 different countries reported being cancer patients. The median age was 51.5 years, 79.9% were female, and 28% had breast cancer. Cancer participants reported higher self-efficacy to follow recommended national guidelines regarding COVID-19 protective behaviors compared to non-cancer participants (p < 0.01). They were less stressed (p < 0.01), more psychologically flexible (p < 0.01), and had higher levels of positive affect compared to non-cancer participants. Amongst cancer participants, the majority (80.3%) reported COVID-19, not their cancer, as their priority during the first wave of the pandemic and females reported higher levels of stress compared to males. In conclusion, cancer participants appeared to have handled the unpredictable nature of the first wave of the pandemic efficiently, with a positive attitude towards an unknown and otherwise frightening situation. Larger, cancer population specific and longitudinal studies are warranted to ensure adequate medical and psychological care for cancer patients.