Abstract
Background
The novel coronavirus SARS-CoV-2 has caused a global COVID-19 pandemic, leading to worldwide changes in public health measures. In addition to changes in the public sector (lockdowns, contact restrictions), hospitals modified care to minimize risk of infection and to mobilize resources for COVID-19 patients. Our study aimed to assess the impact of these measures on access to care and behaviour of patients with thoracic malignancies.
Methods
Thoracic oncology patients were surveyed in October 2020 using paper-based questionnaires to assess access to ambulatory care services and tumor-directed therapy during the COVID-19 pandemic. Additionally, behaviour regarding social distancing and wearing of face masks were assessed, as well as COVID-19 exposure, testing and vaccination. Results are presented as absolute and relative frequencies for categorical variables and means with standard deviation for numerical variables. We used t-test, and ANOVA to compare differences in metric variables and Chi2-test to compare proportions between groups.
Results
93 of 245 (38%) patients surveyed completed the questionnaire. Respiration therapy and physical therapy were unavailable for 57% to 70% of patients during March/April. Appointments for tumor-directed therapy, tumor imaging, and follow-up care were postponed or cancelled for 18.9%, 13.6%, and 14.8% of patients, respectively. Patients reported their general health as mostly unaffected. The majority of patients surveyed did not report reducing their contacts with family. The majority reduced contact with friends. Most patients wore community masks, although a significant proportion reported respiratory difficulties during prolonged mask-wearing. 74 patients (80%) reported willingness to be vaccinated against SARS-CoV-2.
Conclusions
This survey provides insights into the patient experience during the second wave of the COVID-19 pandemic in Munich, Germany. Most patients reported no negative changes to cancer treatments or general health; however, allied health services were greatly impacted. Patients reported gaps in social distancing, but were prepared to wear community masks. The willingness to get vaccinated against SARS-CoV-2 was high. This information is not only of high relevance to policy makers, but also to health care providers.
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Background
The novel coronavirus SARS-CoV-2 has caused a global COVID-19 pandemic, leading to worldwide changes in public health measures. In addition to changes in the public sector (lockdowns, contact restrictions), hospitals modified care to minimize risk of infection and to mobilize resources for COVID-19 patients. Patients with thoracic malignancies may be particularly affected by public health measures. On the one hand these patients may be at risk of severe COVID complications due to advanced age and comorbidities [1, 15].
A survey across several European countries measured the willingness to get vaccinated against COVID-19 in more than 7500 people. They found an overall willingness in 74% of respondents, the willingness in Germany was 70% [16]. According to the Germany COVID-19 Snapshot Monitoring (COSMO Germany) the willingness to get vaccinated in the German population has declined from around 79% in April to 50% in October 2020 [17]. In our survey respondents, the willingness to get vaccinated was higher (80%) than the general German population. This higher proportion may reflect thoracic oncology patient perceptions of their individual risk for complications from COVID-19. Additionally, older patients were more likely to indicate a willingness to get vaccinated. Advanced age as well as having a cancer diagnosis are risk factors for complications from COVID-19 [1, 2].
The survey reported here was conducted in a single lung cancer center in Bavaria, Germany. While the results offer a snapshot of the patient experience in Munich, experiences during the pandemic are likely to vary regionally and may also vary between centers in a region. The survey was intended to capture a broad range of patient experiences and was, therefore, mailed out to patients with all types of primary thoracic malignancy and all stages of disease. It included patients with NSCLC, SCLC, mesothelioma and thymus tumors, with patients currently undergoing treatment as well as patients under surveillance and follow-up care. However, as not all surveys were returned, the results may include an element of bias based on patients’ willingness to participate in the survey. However, we did not find that respondents and non-respondents were significantly different regarding age, gender, histology, and stage. However, the definition of our study exclusion criteria may have introduced a selection bias to patients included and excluded for the study. As lung cancer has a median survival time of less than a year and we looked at tumor board records from the previous three years, a higher proportion of patients with lower stage at diagnosis were left to include after excluding deceased patients and patients who were likely deceased. As can be seen in Fig. 1, the majority of patients excluded were patients with metastatic disease who did not visit our center during the 6 months prior to the begin of our study. We expected that these patients most probably were deceased, and we did not want to risk addressing questionnaires to grieving family members. Additionally, as our questionnaire was mailed out only in the German language, there might be an underrepresentation of patients with non-German first language. Nevertheless, apart from stage, basic demographic parameters suggest that the survey respondents were similar to the average lung cancer patient. Mean age of the respondents was 66.7 years which is close to the mean age at diagnosis of German lung cancer patients (male: 69.3, female: 68.3) [18].The proportion of male patients in our study (60%) was comparable to the proportion of male patients among newly diagnosed patients in Germany in 2016 which was 65% [18].
This is the first study to measure specific consequences of the COVID-19 pandemic on ambulatory services as well as in- and outpatient visits from the perspective of thoracic oncology patients in Germany, and, to our knowledge, internationally. Additionally, the study evaluated effects on patient health and patient’s behavior, views and feelings towards social distancing, mask wearing and vaccination. While several studies have reported the physician perspective and described changes to the provision of care, the patient perspective is particularly valuable in demonstrating the effects of those changes, as well as compliance with distancing and lock-down recommendations. In many respects, our results are reassuring and show that, while the pandemic has forced some changes in care, the majority of patients were able to receive most aspects of care as planed and have coped well with the changes that occurred. Other results, such as the relatively high proportion of patients who report not having limited social or family contacts, imply a need for further public health education measures aimed at specific patient groups. Alternatives to mask-wearing should be investigated for those patients who experience respiratory difficulties during extended periods of community mask use.
Conclusion
This survey of patient experiences demonstrates that the subjective impact of the COVID-19 pandemic on tumor-directed care and general patient health for thoracic oncology patients was minimal. Access to some ambulatory allied health services was greatly reduced. Many patients did not reduce social or family contacts. Most patients wore masks, although many patients reported respiratory symptoms during mask-wearing. The willingness to get vaccinated against SARS-CoV-2 was high. This information is of high relevance to both policy makers and healthcare providers.
Availability of data and materials
The datasets used and analysed during this current study are available from the corresponding author upon reasonable request.
Abbreviations
- SARS-CoV-2:
-
Severe acute respiratory syndrome corona virus 2
- COVID-19:
-
Corona virus disease 2019
- ESMO:
-
European Society of Medical Oncology
- ICD:
-
International classification of disease
- CCI:
-
Charlson comorbidity index
- GP:
-
General physician
- PCR:
-
Polymerase chain reaction
- LCSS:
-
Lung cancer symptom scale
- NSCLC:
-
Non-small-cell-lung-cancer
- COSMO:
-
COVID-19 snapshot monitoring
- SCLC:
-
Small-cell-lung-cancer
- RKI:
-
Robert Koch Institut
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Funding
Open Access funding enabled and organized by Projekt DEAL. This research received funding from Takeda Pharma Vertrieb GmbH & Co. KG.
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Contributions
AT was responsible for conceptualization, methodology, resources, and writing of the original draft. KK, ZS, DK, FM, CS, JB were involved in writing and editing the manuscript. RK was conducting involved in data curation. LS and JW designed the questionnaire, analyzed the data and were involved in writing and editing the original manuscript. All authors read and approved the final manuscript.
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Approval for this prospective non-interventional study was obtained from the Ethics Committee of the Ludwig-Maximilians University. The study was conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines, and local ethical and legal requirements. Questionnaires, patient information and consent to participation forms were mailed out. Only questionnaires accompanied by a signed consent form were used for analysis in the study.
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The authors declare that they have no competing interests.
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Supplementary Information
Additional file 1
: Table S1. Supplemental material: Comparison of age and CCI according to degree of agreement.
Additional file 2: Table S2.
Supplemental material: Comparison of gender, metastatic disease status and education level according to degree of agreement.
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Walter, J., Sellmer, L., Kahnert, K. et al. Consequences of the COVID-19 pandemic on lung cancer care and patient health in a German lung cancer center: results from a cross-sectional questionnaire. Respir Res 23, 18 (2022). https://doi.org/10.1186/s12931-022-01931-z
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DOI: https://doi.org/10.1186/s12931-022-01931-z