COVID-19 Pandemic Impact on Patients With Cancer - a Danish Survey

Since the detection of the novel coronavirus also called COVID-19 in December 2019 it has
affected many people worldwide. The outbreak of coronavirus was categorized as a global
pandemic in March 2020.

The focus of the Danish health care system is on patients infected with COVID-19. In order to
limit the spread of this disease, the Danish government recommends social distancing during
the COVID-19 pandemic. Unfortunately, long-term social distancing and fear of disease can
lead to anxiety, depression and the feeling of loneliness. All these factors might affect the
quality of life (QoL). The fear of the COVID-19 among the Danish population is thought to be
high since cancer referrals to the departments have decreased markedly during the pandemic -
probably because people avoid appointments at the hospital or general practitioner.

A population that may be seriously impacted by the COVID-19 disease is the group of patients
with cancer. Patients with cancer are in a high risk of serious illness of infections because
the cancer and antineoplastic treatment often weaken the immune system. However, no reports
are available regarding higher incidence of COVID-19 in patients with cancer. The patients
with cancer might be practicing social distancing even more than the general population and
the well-being for this group of patients may be even more affected by the COVID-19 disease.

In Denmark, during the coronavirus outbreak different treatment guidelines have been
conducted to minimize the risk of infection with the COVID-19 virus, but also the impact of
pandemic on the cancer treatment and follow-up program. Also European recommendations have
been conducted to help clinicians deal with various aspects of cancer care. Immunotherapy for
patients with cancer can be changed from a 3 week schedule to 6 week schedule and many
palliative radiation treatments can be changed from a schedule of 10 fractions to 5
fractions. Furthermore it is recommended by the European societies of medical oncology and
radiation oncology to avoid hospital appointments for patients with cancer. In follow-up
programmes outpatient clinic visits can be done over the phone or may even be postponed.

Avoiding exposure to the COVID-19 virus can be essential for patients with cancer. The new
pandemic situation can cause serious concerns for this group of patients. Many visits at the
oncological outpatient clinics are being cancelled or appointments are done by phone to avoid
as many contacts to the health system as possible. The lack of face-to-face contact to the
staff at the Departments of Oncology might cause worries and anxiety for the patients and
their relatives, because of the risk of less detailed information regarding side effects of
treatment as well as cancer related symptoms. Patients may also worry that their
antineoplastic treatment will be discontinued or changed due to reduction of visits at the
outpatient clinics. Overall the QoL can be affected for patients with cancer. A structured
and unified approach to COVID-19 prevention and care specific to cancer patients and cancer
centers is highly needed. Many of the initiatives to avoid face-to-face contact during the
COVID-19 pandemic e.g. telephonic or web-technology contacts for consultation may continue in
the time after the COVID-19 pandemic. It is therefore of interest to explore the patients'
QoL and to investigate their satisfaction with cancer treatment and follow-up during the
COVID-19 pandemic.