Patients with cancer frequently experience depressive and anxiety symptoms, which can negatively affect quality of life, adherence to treatment and health service use (1). The reported prevalence of depression and anxiety varies according to cancer-related variables (such as tumor type), their conceptualization and diagnostic methods that are used. In patients with breast cancer the prevalence of mood disorders ranges from 13% to 54% (2) since the time of diagnosis and most commonly in the first year. While there are some factors well known in the literature as having an impact on increasing psychological distress of patients with cancer, such as having a previous psychiatric diagnosis or having low social support (3), there is some evidence of a possible association between stressful life events and cancer (4).
The COVID 19 pandemic, declared by WHO on March 2020, is a global public and mental health crisis that, in addition to the measures adopted to control its spread, can be considered a stressful event and may cause a significant emotional burden, especially for vulnerable groups (5). These groups encompass patients with preexisting mental or physical health issues (including cancer) that may be at higher risk of becoming mentally unwell in response to the pandemic and its associated factors (6).
Thus, the aim of Covid-BOUNCE study being led by the Champalimaud partners is to assess the psychological impact of the COVID-19 pandemic in patients with early breast cancer by measuring associations between symptom severity and COVID-related parameters (e.g. incidence, death rates, and containment measures). The data collection started at the beginning of the recruitment for the Bounce project in January 2019. The study was ongoing when the COVID 19 pandemic started in Europe and data collection has continued, allowing for measurements of psychological variables in five time points until April 2021. Currently, we are performing descriptive statistics and series of multilevel mixed-effects linear regression models to assess two main points:
- If there are differences between groups of patients with cancer (not exposed vs exposed to the pandemic) in the variation of psychological outcomes over the BOUNCE study period;
- If country-level pandemic-related parameters are associated with individual psychological outcomes independently of other individual characteristics.
Preliminary results were presented at a poster session of ESMO Breast Cancer 2021 (7) and updated results will be presented at the EUROPA DONNA Session of the European Breast Cancer Conference (EBCC-13) that was postponed to 16-18 November 2022 and will take place in Barcelona.
1 Ahles, T., Root, J., & Ryan, E. (2012). Cancer- and Cancer Treatment–Associated Cognitive Change: An Update on the State of the Science. Journal Of Clinical Oncology, 30(30), 3675-3686.
2 Ahles, T., & Root, J. (2018). Cognitive Effects of Cancer and Cancer Treatments. Annual Review Of Clinical Psychology, 14(1), 425-451.
3 Asher, A., & Myers, J. S. (2015). The effect of cancer treatment on cognitive function. Clin Adv Hematol Oncol, 13(7), 441-450.
4 Jean-Pierre, P. (2010). Management of Cancer-related Cognitive Dysfunction—Conceptualization Challenges and Implications for Clinical Research and Practice. Oncology & Hematology Review (US), 06, 9.
5 O’Farrell, E., MacKenzie, J., & Collins, B. (2013). Clearing the air: A review of our current understanding of “chemo fog.” Current Oncology Reports, (3):260-9.
6 Vannorsdall, T. (2017). Cognitive Changes Related to Cancer Therapy. Medical Clinics Of North America, 101(6), 1115-1134.
7 Wefel, J., & Schagen, S. (2012). Chemotherapy-Related Cognitive Dysfunction. Current Neurology And Neuroscience Reports, 12(3), 267-275.
8 Vannorsdall, T. (2017). Cognitive Changes Related to Cancer Therapy. Medical Clinics Of North America, 101(6), 1115-1134.
9 NCCN®. Version 2.2019, 06/05/19 © 2019 National Comprehensive Cancer Network®.
By Sílvia Almeida, Berta Sousa and Albino Oliveira Maia, Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal