Investigating the effects of the COVID-19 lockdown on cancer patient self-reported symptom intensity in a Southwestern Ontario Cancer Center

Background: The longitudinal impact of the COVID-19 pandemic on patient-reported outcomes (PRO) in the cancer patient population is an important and under-investigated issue that can inform comprehensive care. Reduced access to medical care was problematic for cancer patients, as they require frequent treatments and appointments. Hypotheses: PROs of cancer patients measured through the Edmonton Symptom Assessment Scale Revised (ESAS-r) would be negatively impacted during the lockdown, followed by recovery to baseline once measures lifted. Methods: To trend PROs in cancer patients, we anonymized ESAS-r data collected at a southwestern regional Cancer Program from January 2019 to December 2023 (n=45,896). Results: Contrary to our hypothesis patients reported less severe symptoms (mIQR=13(22)) during the pandemic compared to before (mIQR=15(24), P<0.001) or once the lockdown was lifted (mIQR=16(24), p<0.001). Upon subsetting the data to surveys completed at home (n=4,820) versus in-clinic (n=29,858), individuals’ scores gathered during lockdown in-clinic were comparable to baseline (p=0.64). Implications: These results suggest that patients perceived less severe symptoms at home during the lockdown, which could be due to feeling safer, not having to go out, and being more physically comfortable. Whereas more ill patients needed to visit the clinic to receive care. Although this study was limited to a single setting, it demonstrated the unpredictable effects COVID-19 had, highlighting the importance of further exploring the lasting impact of the global crisis on cancer patientsHypotheses: PROs of cancer patients measured through the Edmonton Symptom Assessment Scale Revised (ESAS-r) would be negatively impacted during the lockdown, followed by recovery to baseline once measures lifted. Methods: To trend PROs in cancer patients, we anonymized ESAS-r data collected at a southwestern regional Cancer Program from January 2019 to December 2023 (n=45,896). Results: Contrary to our hypothesis patients reported less severe symptoms (mIQR=13(22)) during the pandemic compared to before (mIQR=15(24), P<0.001) or once the lockdown was lifted (mIQR=16(24), p<0.001). Upon subsetting the data to surveys completed at home (n=4,820) versus in-clinic (n=29,858), individuals’ scores gathered during lockdown in-clinic were comparable to baseline (p=0.64). Implications: These results suggest that patients perceived less severe symptoms at home during the lockdown, which could be due to feeling safer, not having to go out, and being more physically comfortable. Whereas more ill patients needed to visit the clinic to receive care. Although this study was limited to a single setting, it demonstrated the unpredictable effects COVID-19 had, highlighting the importance of further exploring the lasting impact of the global crisis on cancer patients.