The Impact of Changes in Service Delivery in Patients With Colorectal Cancer During the Initial Phase of the COVID-19 Pandemic

We investigated the perception of service changes imposed by COVID-19 and identified determinants of anxiety in patients with colorectal cancer. A 32-item survey, including the General Anxiety Disorder-7 tool, was performed in a tertiary cancer center. Of 143 participants, 23 (18%) have anxiety (General Anxiety Disorder-7 score 5); 7 (6%) moderate/severe anxiety. An easy and practical pre-screening assessment questionnaire can help identify those in more need of further support. Background: The Coronavirus disease 2019 (COVID-19) pandemic has imposed significant changes in cancer service delivery resulting in increased anxiety and distress in both patients and clinicians. We aimed to investigate how these changes have been perceived by patients diagnosedwith colorectal cancer and identify determinants of increased anxiety. Patients and Methods: An anonymized 32-item survey in the specialized lower gastrointestinal cancer outpatient clinics at a tertiary cancer center in North West England between May 18 and July 1, 2020. Self-reported anxiety was based on the General Anxiety Disorder-7 screening tool. Results: Of 143 participants who completed the survey (response rate, 67%), 115 (82%) were male, and the median age group was 61 to 70 years. A total of 112 (78%) participants had telephone consultation (83% met needs), and 57 (40%) had radiologic scan results discussed over the phone (96% met needs). In total, 23 (18%) participants were considered to have anxiety (General Anxiety Disorder-7 score >= 5), with 7 (5.5%) scoring for moderate or severe anxiety. Those concerned about getting COVID-19 infection, and worried COVID-19 would have effect on their mental health, and affect their experience of cancer care, were most likely to have anxiety (P <.05, multivariate analysis). The majority did not feel they needed support during this phase of the pandemic. Participants felt that friends and family had been very supportive, but less so the primary care services (P <.05). Conclusions: The findings of this survey suggest that some of the service changes implemented may have already improved the overall experience of cancer care among patients with colorectal cancer at our institute. Reassuringly, the incidence of participants with moderate to severe anxiety levels during the peak of COVID-19 in the United Kingdom was much lower than anticipated. Importantly, patients were much more concerned about their cancer treatment than COVID-19, emphasizing the need to continue to provide comprehensive cancer care even with a second wave of COVID-19. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

This study investigated the perception of service changes due to COVID-19 in patients with colorectal cancer, identifying determinants of anxiety. Results showed concerns about COVID-19 infection, impact on mental health, and cancer care experience as key factors for anxiety in patients.