Resilience in the Face of Pandemic: The Impact of COVID-19 on the Psychologic Morbidity and Health-Related Quality of Life Among Women With Ovarian Cancer

Abstract

QUESTION ASKED: How have ovarian cancer survivors' quality of life and mental well-being been affected by the COVID-19 pandemic? SUMMARY ANSWER: Ovarian cancer survivors' health-related quality of life has been preserved, particularly in those with high resilience, despite the challenges posed by the COVID-19 pandemic. WHAT WE DID: Patients with advanced-stage ovarian cancer treated at The University of Chicago were contacted by phone to participate in a cross-sectional survey to assess the impact of COVID-19 on their well-being in May and June 2020. Psychologic domains were explored using abbreviated validated measures including health-related quality of life (HRQOL; functional assessment of cancer therapy), anxiety (generalized anxiety disorder-7), depression (Patient Health Questionnarie-2), global health (PROMIS-GMH/GPH), resilience (brief resilience scale), and loneliness (English Longitudinal Study on Aging). Novel questions specific to COVID-19 were also drawn from a larger survey on women's health conducted out of our department. WHAT WE FOUND: High resilience, older age, being off chemotherapy, and having high self-rated mental health predicted higher HRQOL on multiple regression analysis. Concern about the pandemic was lower in survivors with high resilience and recurrent cancer. Resilience was prevalent within the population, with 90% of patients having high or normal resilience. Overall HRQOL was good (median 5 21; range 5 6-29). Rates of depression (2%) and moderate or severe anxiety (4%) were lower than anticipated. Notably, increased loneliness during the pandemic was a vulnerability reported by 43% of respondents. BIAS, CONFOUNDING FACTORS, DRAWBACKS: Our sample size was small with 61 respondents, and the survey only reflected survivors' experiences at a single time point. Abbreviated psychologic measurements were used, which might have decreased accuracy. The respondents were drawn from a pool of patients seeking care at an urban academic medical center, which may not reflect the ovarian cancer survivor population as a whole. REAL-LIFE IMPLICATIONS: Psychologic and supportive survivorship care is easy to deprioritize when the medical system is strained by the pandemic. Ovarian cancer survivors are resilient, and this translated to well-preserved HRQOL despite the pandemic. However , many survivors also reported a recent increase in loneliness, which is a threat to their resilience and well-being as the pandemic wears on. Oncology practices should continue to promote resilience building interventions across psychologic, physical, and social domains to comprehensively support our cancer survivors. abstract PURPOSE The COVID-19 pandemic has created new challenges for ovarian cancer survivors. This study aims to evaluate the psychologic morbidity and alterations in medical care caused by the pandemic. METHODS Advanced-stage ovarian cancer survivors at our institution were contacted for participation in a cross-sectional telephone-based quantitative survey study assessing pandemic-related psychologic morbidity. Psychologic domains using validated measures were explored: health-related quality of life (HRQOL; functional assessment of cancer therapy [FACT-G7]), anxiety (generalized anxiety disorder-7 [GAD7]), depression (Patient Health Questionnarie-2 [PHQ2]), global health Patient-Reported Outcomes Measurement Information System-Global Physical Health/ Global Mental Health (PROMIS-GMH/GPH), resilience (brief resilience scale), and loneliness (English Longitudinal Study on Aging). Novel COVID-19 pandemic questions were drawn from a larger survey developed in our department. RESULTS Fifty-nine percent (61 of 104) of contacted patients completed the survey. One quarter of respondents had high resilience, with only 10% reporting low resilience. Only one patient screened positive for depression, and two for anxiety. Increased loneliness was reported by 43% of respondents. Patients' overall HRQOL was good (median 5 21; range 5 6-28). Few patients experienced treatment delays, with only four experiencing chemotherapy interruption and two reporting surgical delays. Multiple regression analyses revealed that high FACT-G7 HRQOL was predicted by age. 65 years, high self-reported mental health, high resilience, and being off chemotherapy. Lower COVID-19 concern was predicted by recurrent cancer and high resilience. CONCLUSION Despite the far-reaching impact of the COVID-19 pandemic, ovarian cancer survivors' HRQOL has been maintained. Older age, high resilience, high mental health, and being off chemotherapy predicted better HRQOL. Ovarian cancer survivors remain resilient in the face of the pandemic, and the support of clinicians to preserve this invaluable personal resource is critical for well-being.