Scientists and policymakers have formulated various pharmaceutical and non-pharmaceutical strategies to contain the ongoing coronavirus disease 2019 (COVID-19) pandemic. Long-term national lockdowns and curfews are non-pharmaceutical measures that have tremendously impacted the global population in terms of physical and mental health and social and financial conditions.
Study: Post-traumatic stress symptoms in cancer patients during the COVID-19 pandemic: a one-year longitudinal study. Image Credit: Dmitry Demidovich/Shutterstock
Post-traumatic stress disorder and pandemics
Post-traumatic stress disorder (PTSD) is caused by direct or indirect exposure to a stress element. Common PTSD symptoms are anxiety, distress, depression, intrusive memories, avoidance, etc. Several studies have indicated the occurrence of PTSD during past epidemics, such as severe acute respiratory syndrome (SARS), Ebola, and H1N1 influenza. These studies have revealed that PTSD symptoms are compounded by some public health measures, such as quarantine requirements.
Scientists have stated that unprecedented and repetitive waves of COVID-19 cases have long-term psychological consequences. Although many studies have reported the high prevalence of PTSD during the current COVID-19 pandemic, most of these studies were cross-sectional or short follow-up periods. A meta-analysis, which comprised thirty-nine studies, showed the prevalence of PTSD symptoms in 27% of the population during the first wave of the pandemic.
A study conducted in France reported 35.5% of the population exhibited clinically significant COVID-19 peritraumatic distress during the first lockdown. Once the restrictions were relaxed after three months, the percentage of the population suffering from peritraumatic distress reduced to 17.2%. However, not many researchers have repeated these assessments to evaluate changes in PTSD patterns over time.
Cancer patients and post-traumatic stress disorder
Previous studies have shown that cancer patients are particularly vulnerable to PTSD. This is due to a high baseline level of anxiety and depression due to the significant modifications of cancer management in response to the COVID-19 pandemic and the knowledge of their susceptibility to developing severe COVID-19 infection. Many studies associated with different types of cancers have shown the development of PTSD during the first wave of COVID-19 infection. Scientists have observed a lack of longitudinal study associated with PTSD of cancer patients over the different waves of the pandemic.
A new study
In April 2020, scientists designed a one-year longitudinal prospective clinical cohort of French cancer patients (COVIPACT). This study cohort included cancer patients with hematologic malignancy and who were under treatment during the first nationwide lockdown. PTSD symptoms were estimated every three months from April 2020 by means of the Impact of Event Scale Revised. Patients were asked to fill up validated questionnaires on quality of life (QoL), cognitive complaints, and insomnia. Scientists also analyzed and reviewed their COVID-19 lockdown experience.
Recently, scientists conducted a longitudinal follow-up of the COVIPACT cohort and published their findings on the medRxiv* preprint server. The main focus of this study was to investigate the evolution of PTSD symptoms in cancer patients over the first year of the COVID19 pandemic. Scientists also determined the factors that influenced high PTSD symptoms. They also examined the progression of cognitive complaints, insomnia, and QoL, over the pandemic with regard to PTSD symptoms.
This study revealed that almost one-quarter of cancer patients experienced high levels of PTSD symptoms. This group comprised cancer patients who were socially isolated during the lockdown, female patients, and those who feared COVID-19 infections and were under increased use of psychotropic drugs. The baseline result revealed that 21% of cancer patients suffered PTSD due to poor QoL during the first COVID-19 lockdown. This finding aligns with an Italian study of lymphoma patients treated during the same period. However, a higher prevalence of PTSD of 35% was reported among breast cancer patients in China.
The current study revealed that PTSD symptoms declined substantially after relaxing restrictions during the summer of 2020. During this time, 13.6% of patients showed moderate-to-severe PTSD symptoms. Scientists also reported a decrease in peritraumatic distress and anxiety from the early stages of lockdown to the time when the restrictions were relaxed.
However, researchers found an increase in PTSD symptoms during the second lockdown. This finding implies a correlation between the psychological distress of cancer patients and the series of restrictions and release periods. Interestingly, this trend was not observed during the third lockdown, which might be due to the commencement of the COVID-19 vaccination.
Sleep disturbance, high psychological distress, poor QoL, and more cognitive and insomnia complaints have been associated with PTSD. During the first year of the pandemic, almost a quarter of French cancer patients experienced moderate distress throughout the period, whereas 17.6% of patients experienced serious symptoms during the second lockdown.
As this study had no control group, scientists could not confirm if the evolution of some PTSD symptoms were specific to cancer patients. The authors also reported that female patients experienced more symptoms of PTSD compared to males during this pandemic. The main strength of this study is the long-term follow-up of the cancer patients’ psychological distress, which has been correlated with poor adherence to treatment and survival.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.