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The psychological impact of the COVID-19 epidemic and the lockdown on cancer patients

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Journal Identification = NRP Article Identification = 0639 Date: June 16, 2021 Time: 4:28 pm

doi:10.1684/nrp.2021.0639

REVUE DE NEUROPSYCHOLOGIE

NEUROSCIENCES COGNITIVES ET CLINIQUES

72

Point of view

Rev Neuropsychol

2020 ; 12 (S1) : 72-4

The psychological impact

of the COVID-19 epidemic and the lockdown on cancer patients *

Impact psychologique de l’épidémie de Covid-19 et du confinement

chez des patients pris en charge pour un cancer

Bénédicte Giffard1, Florence Joly2

1Normandie université, UniCaen, PSL université, EPHE, Inserm U1077, CHU de Caen, Neuropsychologie et imagerie de la mémoire humaine, 2, rue des Rochambelles, 14032 Caen cedex CS, France

<benedicte.giffard@unicaen.fr>

2Centre Franc¸ois-Baclesse, U1086 Inserm-UniCaen (Anticipe), 3 avenue du Général Harris, 14000 Caen, France

To cite this article: Giffard B, Joly F.

The psychological impact of the COVID- 19 epidemic and the lockdown on cancer patients.Rev Neuropsychol2020;12(S1):72- 4 doi:10.1684/nrp.2021.0639

“We are at war”

These words pronounced several times by the French Head of State on the evening of 16 March 2020, the day before the lockdown in France, induced, for those who had not yet been aware of it, anxiety in link with dimension to the COVID-19 epidemic, which was spreading in a wor- rying way. This situation, rarely experienced serenely by anyone, was particularly difficult for vulnerable people such as patients treated for cancer. These patients have multiple sources of anxiety: between the fear of contracting the virus in care centre and the fear linked to the modification of treat- ment protocols, between uncertainty of the course of the cancer and the obligation imposed by the confinement to further increase their isolation. These sources of stress have been multiplied and may have an impact on immune sys- tem. Patients can thus experience this pandemic as a double punishment.

Frail patients more at risk of coronavirus infection

These patients, frail due to age-related co-morbidities, immunosuppression linked to cancer and medical treat- ments, are more exposed to the risk of infection by

This article is an English language translation of the following article:

Giffard B, Joly F. Impact psychologique de l’épidémie de Covid-19 et du confinement chez des patients pris en charge pour un cancer.Rev Neuropsychol2020 ; 12 (2) : 193-5 doi:10.1684/nrp.2020.0569.

Correspondence:

B. Giffard

SARS-CoV-2, with a risk of developing severe forms and major complications[1, 2]. In case of confirmed diagnosis of infection, the risk of developing severe disease is increased by a factor of 3.5[3]. A recent study has shown that half of the patients had a severe course of infection, particularly if they had recently received oncological treatment[4].

A “degraded” support

The care of patients treated for cancer has been disrupted in hospitals and cancer centres since the beginning of the health crisis. Based on the recommendations of oncology societies, many care centres have modified their treatment procedures to limit the risk of contamination by the virus in these frail patients. As a result, some treatments have been suspended or some alternatives have been proposed.

Non-urgent operations, such as breast reconstructions, have been postponed. While the recommendations encourage, as far as possible, the continuation of current medical treatments, they also propose some adjustments of the modalities (rhythm of administration of treatments, num- ber and/or interval of cycles), and the postponement of the initiation of certain treatments in case of particular risk situations[5]. It is also recommended to privilege oral medical treatments rather than intravenous ones. Similarly, some monitoring consultations have been postponed, oth- ers carried out by teleconsultation or by telephone in order to avoid patients having to go to hospital. Although this forced digitalisation of health care anticipates one of the measures of the “Ma Santé 2022” plan, telemedicine has some limits particularly among elderly patients who are not

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Journal Identification = NRP Article Identification = 0639 Date: June 16, 2021 Time: 4:28 pm

REVUE DE NEUROPSYCHOLOGIE

NEUROSCIENCES COGNITIVES ET CLINIQUES

73

Point of view

familiar with connected tools. Moreover, this solution does not replace the face-to-face meeting to offer optimal global care, particularly in the field of oncology. Even if remote psychological support platforms have been set up to deal with patients’ psychological distress, supportive care, which aims to improve the overall quality of life on a physical, social and psychological level, has been suspended in most centres.

Psychological distress

Face to the pandemic, the fear of the risk of infection, combined with adjusted medical care sometimes judged to be less effective, can lead to legitimate concern and anxiety among cancer patients[6]. Characterized psychiatric disor- ders are also likely to emerge with depressive symptoms or symptoms of post-traumatic stress disorder. The long period of the lockdown, and the uncertainty about this duration, may also have had a negative impact on stress among the whole population, and even more for vulnerable people.

This period of chronic stress could have biological effect with for example excessive secretion of cortisol, deleteri- ous effect on immunity and indirectly on negative impact on the growth of cancer cells.

As the world’s first infected area, Chinese teams were the first to publish results on the psychological impact of this situation on the general population [7, 8]. Among more than 1,200 people interviewed during the initial phase of COVID-19 in China, more than half of the par- ticipants felt a moderate to severe psychological impact, and a third reported moderate to severe anxiety. The high- est levels of stress, anxiety and depression were observed among women, students, people with physical symptoms and lower levels of health. These results are highly likely to be increased in people with cancer, but studies specific to cancer are few at present[9].

Patients’ isolation and feelings of loneliness are ampli- fied by lockdown and fear of contracting the virus.

Caregivers usually help to maintain a connection with patients who are already isolated because of their cancer and help them cope with managing illness and stress. How- ever, the pandemic has led to an increased deprivation of these relationships: physical contact, which previously represented support and comfort for patients, has become a danger. Patients diagnosed and treated for cancer are already very vulnerable psychologically, so the support of carers and psycho-oncology professionals becomes essen- tial during this period, including when support is provided at a distance by video consultation or by telephone.

A psychological impact for caregivers

The oncologic departments had to quickly readjust and adapt the management of the patients treated, plan and modify their follow-up, and reorganise treatments. Surgi-

cal procedures had to be postponed or even cancelled, as well as follow-up examinations. This is a disruption for the patients, but also for the caregivers, who are forced to make sudden changes in their care, not always optimal, with some feelings of frustration[10]. Similarly, this pandemic has an organisational impact on primary care health professionals, particularly general practitioners, pharmacists and private nurses, who are going through an unprecedented period, challenging their daily practice and their choice of how best to treat patients with cancer. The responsibility of making sometimes non-optimal choices is heavy to bear and the information difficult to explain to the patient. These same caregivers are also worried about carrying the infection to their relatives, especially in the case of contact with people close to those at risk.

What next?

While the first lockdown ended in May in France, many uncertainties remained about the evolution of the situation.

The long-awaited end of lockdown does not mean the end of the spread of the virus. Some Chinese studies show that stress-related symptoms do not stop after the end of lock- down and despite the reduction of the epidemic. Some stress factors persist or emerge, such as the fear of being infected by the virus, the fear of a rebound of the epidemic and a “second wave”, or possibly the return to work for those concerned, and the socio-economic consequences of this health crisis.

Axel Kahn, the president of the French League Against Cancer, recently expressed his concern about the sharp drop in the number of cancers diagnosed during the two months of lockdown. The number of new cancers has been halved, leading to fears that patients will be treated too late and that the delay in diagnosis and treatment may reduce the chances of recovery. This situation is highly likely to lead to saturation when cancerology activities are resumed normally.

An unprecedented situation

with unprecedented psychological consequences?

The psychological impact of this unprecedented health crisis on populations, and particularly on vulnerable populations, remains uncertain but will undoubtedly be profound. However, it is not the first case and we did not draw some conclusions. Who still remembers the mondial Hong Kong flu, which caused nearly 35,000 deaths between the end of 1969 and the beginning of 1970 in France alone?

It seems strange today that this worldwide epidemic and its consequences, which received very little media coverage, have not left a lasting impression on people’s memories, including caregivers. The scarcity of public health mea-

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Journal Identification = NRP Article Identification = 0639 Date: June 16, 2021 Time: 4:28 pm

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Point of view

sures at the time, combined with the almost total absence of media coverage, contrasts with the measures and warlike rhetoric of politicians and the daily special editions related to Covid-19. Can these profound changes in the space of a few decades be explained by changes in our relationship to death and our perception of disease? The consequences and risks associated with Covid-19 have been sufficiently pub- licised to have an impact on our mentalities. We know our individual memory shaped by collective representations.

We can ask ourselves the question of the impact of these col- lective representations and memories on the psychological and psychiatric consequences on the population in general and on cancer patients in particular.

Conflict of interest None.

References

1.Dai M, Liu D, Liu M,et al. Patients with Cancer Appear More Vulnerable to SARS-COV-2: A Multicenter Study during the Covid-19 Outbreak. Cancer Discov2020 ; 10 : 1-9.

2.Liang W, Guan W, Chen R,et al. Cancer patients in SARS-CoV- 2 infection: a nationwide analysis in China. Lancet Oncol2020 ; 21 : 335-7.

3.Guan WJ, Liang WH, Zhao Y,et al.Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis.

Eur Respir J2020 ; 2000547 [Published online ahead of print, 2020 Mar 26].

4.Guan WJ, Ni ZY, Hu Y,et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med2020 ; 382 : 1708-20.

5.Kutikov A, Weinberg DS, Edelman MJ,et al.A War on Two Fronts:

Cancer Care in the Time of Covid-19.Ann Intern Med2020 ; 172 (11) : 756-758 [published online ahead of print, 2020 Mar 27].

6.Dalal NV. Social issues faced by cancer patients during the coro- navirus (Covid-19) pandemic. Cancer Res Stat Treat2020 ; 3(Suppl.

S1) : 141-4.

7.Qiu J, Shen B, Zhao M,et al. A nationwide survey of psychological distress among Chinese people in the Covid-19 epidemic: implica- tions and policy recommendations. General Psychiatry 2020 ; 33 : e100213.

8.Wang C, Pan R, Wan X, et al. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (Covid-19) Epidemic among the General Population in China. Int J Environ Res Public Health 2020 ; 17(5) : 1729.

9.Porzio G, Cortellini A, Bruera E, et al. Home care for cancer patients during Covid-19 pandemic: The double “triageprotocol”.

J Pain Symptom Manage2020 ; Mar 30. pii: S0885-3924(20)30172-X.

doi:10.1016/j.jpainsymman.2020.03.021.

10.Abdessater M, Rouprêt M, Misrai V,et al. Covid-19 pandemic impacts on anxiety of French urologist in training: Outcomes from a national survey [published online ahead of print, 2020 Apr 23].Prog Urol2020 ; S1166-7087(20)30137-8. doi:10.1016/j.purol.

2020.04.015.

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