Impact of Demographic Characteristics on Self-Reported Psychological Distress of Cancer Patients during the COVID-19 Pandemic

PURPOSE/OBJECTIVE(S): To investigate how at-risk demographic features correlate with the perceived level of psychological distress in cancer patients actively receiving care during the COVID-19 pandemic. MATERIALS/METHODS: Patients treated with radiotherapy at a single academic cancer center were reviewed 3 months before (11/01/2019-03/16/2020) and during (03/17/2020- 2/01/2021) the COVID-19 pandemic. Patients who reported an NCCN distress score (range 0=no distress to 10=extreme distress) as a part of their radiation care were reviewed for inclusion. Variables of interest were extracted from the medical record including age, gender, ethnicity, and Karnofsky Performance Scale (KPS) score. Distress scores were recorded around the time of simulation or treatment start. The relationship between these variables and NCCN distress scores were assessed using univariate and multivariate linear regression. RESULTS: Of all the patients receiving active treatment during the study interval (n=3,129), a total of 2,012 patients reported distress scores and thus were included. Median pre-pandemic distress was 3 (Interquartile Range 0-5) compared to median score of 2 (IQR 0-4) during the pandemic. There was no change in pre- and during pandemic distress on subgroup analysis by age, gender, ethnicity, or KPS score. The following variables were significantly correlated with increased distress on univariate analysis: older age (beta-age = -0.0163 [95% CI: -0.0262 to -0.0063], female gender (OR = 2.43 [95% CI 1.88 to 3.03], race (“black” race OR = 2.77 [95% CI: 1.68 to 4.57] and “other” race OR 1.96 [95% CI: 1.34-2.83]) and lower KPS score (beta-KPS = -0.403 [95% CI: -0.509 to -0.298]. Multivariate analysis was used to test if these demographic features were correlated with psychological distress among all patients. The overall regression was statistically significant albeit with a small effect size (R2=0.0605, p < .0001). On multivariate analysis, the following variables remained significant: age (beta-age = -0.0145 [95% CI: -0.0266 to -0.00241]), KPS score (beta-KPS = -0.429 [95% CI: -0.561 to -0.297]), and female gender (OR = 1.88 [95% CI: 1.28-2.75]). CONCLUSION: The ongoing COVID-19 pandemic did not significantly affect patient-reported distress levels at the time of receiving cancer-directed therapy. Older age, female gender, and low KPS score were associated with higher psychological distress in cancer patients receiving radiotherapy. Current analysis reveals vulnerable populations of cancer patients may have higher risk of distress during radiotherapy. These populations would warrant additional surveillance during treatment and may benefit from additional psychosocial support.