A Tale of Two Pandemics: Cancer Coping and Care Delivery During the COVID-19 Pandemic (RP402)

OUTCOMES: 1. Understand how to prepare cancer and palliative care delivery systems for future COVID-related surges or pandemics that necessitate changes in delivery of cancer and palliative care services 2. Understand cancer and palliative care clinician burnout IMPORTANCE: The COVID-19 pandemic profoundly disrupted cancer and palliative care delivery. OBJECTIVES: Use mixed methods to explore the impact of the pandemic on cancer and palliative care delivery among cancer patients, family caregivers, and cancer and palliative care clinicians. METHODS: Quality-of-life and COVID-specific surveys were distributed to cancer patients and family caregivers in four US geographic areas. In-depth interviews were conducted with cancer patients, family caregivers, and cancer and palliative care clinicians. RESULTS: From August 2020 through July 2021, data were collected in Baltimore, MD; Boston, MA; Albuquerque, NM; and Stanford, CA and include 499 surveys from 188 cancer patients and 26 family caregivers and 71 interviews from 48 cancer patients, 4 family caregivers, and 19 cancer and palliative care clinicians. Participants included patients who were recently diagnosed, those who were undergoing active anticancer treatment or had completed treatment, and those receiving end-of-life care. Three patients contracted COVID, with all having mild disease. There were no associations between quality-of-life and/or mood scores and regional COVID surges. Both cancer patients and family caregivers reported good COVID and cancer coping and noted more concern about cancer. Telehealth was widely used and well received. 58% of surveys documented the respondent receiving a recent cancer treatment, but only 5.3% reported knowledge of any COVID-related treatment change. These data contrast with reports from cancer and palliative care clinicians who noted widespread pandemic-related changes in treatment and experienced severe personal anxiety, fatigue, burnout, and moral distress. CONCLUSIONS: In a large and geographically diverse sample, cancer patients and family caregivers coped well with the pandemic and were generally unaware of pandemic-related cancer care changes. In contrast, cancer and palliative care clinicians reported widespread cancer care delivery changes and significant personal pandemic-related anxiety, fatigue, burnout, and moral distress. IMPACT: Although cancer and palliative care delivery systems sufficiently supported patients and family caregivers during the pandemic with both groups noting good coping, cancer and palliative care clinicians reported significant pandemic-related anxiety, fatigue, burnout, and moral distress.