Significant Number of Oncology Patients May Be Experiencing Loneliness and Symptom Burden Due to COVID-19 Pandemic

A significant number of oncology patients reported experiencing loneliness and a higher symptom burden, likely as a result of mandated social distancing and isolation procedures to prevent the spread of COVID-19, according to a study published in Cancer.

While previous studies examined the prevalence and severity of loneliness in the general population, none had evaluated for the occurrence of and risk factors for loneliness in oncology patients during the COVID-19 pandemic. The researchers sought to determine this while examining differences in demographic, clinical and symptom characteristics associated with oncology patients reporting loneliness.

The researchers recruited patients through a registry of individuals who previously participated in National Cancer Institute-funded studies as well as from the Dr. Susan Love Foundation for Breast Cancer Research. The participants were asked via email to complete a 60-minute survey, including a demographic questionnaire and information about their cancer diagnosis, height, weight, treatments and presence of metastatic disease.

Researchers used a 20-item UCLA Loneliness Scale to measure subjective feelings of loneliness and social isolation, rated one (never) to four (often). They also assessed symptoms using various anxiety, sleep disturbance, fatigue, attention function and pain scales.

Out of the 606 patients who completed the survey, 53% were categorized in the lonely group. This group was significantly younger than the nonlonely group, less likely to be married or partnered, more likely to live alone and reported lower household incomes. Patients in the lonely group also had a lower Karnofsky Performance Scale (KPS), which classifies functional impairment, a higher number of comorbidities and were more likely to self-report a diagnosis of depression and back pain.

The lonely group had higher levels of social isolation, higher occurrence and severity rates of the symptoms that were evaluated (depressive symptoms, anxiety, sleep disturbance, morning and evening fatigue and pain/pain interference). They also had significantly lower scores for morning and evening energy and attentional function.

Individuals between 50 and 59 years of age reported higher levels of loneliness than older age groups. Those in lower levels of household income were also associated with higher levels of loneliness.

“Older adults may report lower levels of loneliness because they adapt their needs for social contact to the opportunities that are available to them,” the study authors wrote.

The long-term effects of the COVID-19 pandemic on oncology patients remains to be determined, the authors added. In efforts to combat these effects, the researchers provided several things clinicians can do, including suggesting strategies to patients to prevent or alleviate effects of loneliness; encouraging patients to maintain contact with friends and family using appropriate social distancing procedures/personal protective equipment or via telephone and social media; encouraging patients to structure daily routines including exercise and outdoor activities, a healthy diet and sufficient sleep; and determining when patients may need to be referred to mental health professionals for psychiatric evaluation/counseling.

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