COVID-19 pandemics has brought significant alteration to healthcare systems which transversally affect all types of diseases’ management with severe psychological effects defined as alterations on worries and mood [5–7].
Although cancer care/treatment in the different centers or departments was not stopped during national lockdown, this imposition caused profound alterations in the system dynamics which may have induced delays in cancer diagnosis and treatment. Nevertheless, in contrast with our expectations, cancer patients who participated in this study only strongly noticed the inability of having an accompanying person in medical appointments.
Importantly, the vast majority of patients in this study remained confident in their treatment plan, did not perceive any significant differences in care delays and had no difficulty obtaining medicines in pharmacies during the first lockdown. These results might indicate that the decreased affluence to hospitals and patient triaging could have helped the providers to focus and care more efficiently for those who are still coming to clinics [4]. In fact, in Portugal, there was a 40% reduction in the number of breast cancer patients during lockdown [16].
Fear of COVID-19 infection was by far the most represented worry reported in this study followed by concerns about self-security and the wellbeing of others, such as friends or family member. These results are in line with previous observations, where the majority of the patients (more than 60% of the studied population) expressed fears about contracting the virus [17–19].
Associations between the sociodemographic variables and major concerns strongly vary across studies [20]. Within the population studied, those with low levels of education expressed elevated levels of fear of contracting COVID-19. Although there are inconsistencies, studies pointed out health literacy as an effective tool in management and health outcomes [21–23]. Due to the novelty of the COVID-19 virus, detailed information about the mode of transmission of the virus, signs, and symptoms, and how to effectively apply protective measures might help to mitigate the anxiety and fears even in low educated populations.
Patients whose therapeutic approach is curative were more likely to report increased anxiety levels and concerns about job loss. These findings suggest that stronger protective social measures should be implemented to combat this potentially catastrophic indirect result of COVID-19. As unemployment aggravates the psychological consequences of diseases [24], interventions need to focus on both physical and mental health.
In addition, patients who lived alone were more prone to feel loneliness and anxious about cancer progression. Studies conducted in different countries such as the United Kingdom, the United States of America, Spain and Singapore, also found that living alone increased the feelings of loneliness, an important condition which affects both the mental and physical wellbeing of a person [25–27]. In this way, adequate social support and interpersonal contacts are of greatest importance to one’s health, in particularly during a global pandemic [28].
Despite the worries, cancer participants appeared to have efficiently coped with the unpredictable nature of the first wave of COVID-19 pandemic, maintaining a positive attitude towards an unknown situation. This fact might be partially justified as only patients with oncology appointments who did go to them responded to the survey. The patients who were self-electing to postpone or cancel their cancer appointments and treatment, probably more worried about getting infected with COVID-19 and developing severe complications were not included in this study.
The findings of this study should be considered in light of some limitations. First, the small sample size. Then, the cross-sectional design of the study, besides not allowing extrapolation to big populations, only collects the data at a single moment in time. As the pandemic and associated psychosocial impacts continuously evolve, it was not possible to ascertain the long-term impact of the pandemic and the impact on mental health. Nevertheless, to the best of our knowledge, this study is the first cross-sectional survey in oncology patients to assess the impact of the COVID-19 pandemic in Portugal.