Despite the threat COVID-19 poses to individuals with lung cancer, researchers at The Ohio State University were surprised by the fortitude they displayed in the face of the pandemic. People without cancer were twice as likely to meet the criteria for clinical anxiety and depression during the early months of the pandemic compared to those with lung cancer.
“We were astounded at how resilient these lung cancer patients were in coping with the threat of COVID-19, given they were already under very difficult health circumstances,” said study coauthor Barbara Andersen, a professor of psychology at The Ohio State University, in a press release. “That’s not to say lung cancer patients were unfazed by the pandemic—they did show concern,” Andersen added. “But they seemed better able to handle the stress than similar people without cancer.”
Published online in the Journal of the National Comprehensive Cancer Network and conducted in collaboration with Ohio State’s Comprehensive Cancer Center, the Beating Lung Cancer in Ohio (BLCIO) study challenged the initial assumption that lung cancer patients might not have coped as well as those without cancer, according to Andersen. Past studies have shown that among all cancer patients, people with lung cancer are the most emotionally distressed and have higher rates of mood and anxiety disorders. “It would have been easy to assume that COVID would add further stress to these patients,” she said.
BLCIO included 76 patients with advanced-stage non-small-cell lung cancer, the type that accounts for 85% of all lung cancer cases. The study began before the pandemic and surveyed participants about their psychological health when they were diagnosed, at least a year before the global lockdown. Similar surveys administered between April and July 2020 included specific questions concerning COVID-19.
Researchers found that about 40% of lung cancer patients had moderate to severe depression when diagnosed. But compared with a control group of 67 people without a cancer diagnosis, also from Ohio and with similar education and income levels, the lung cancer patients showed lower levels of anxiety and depression during the pandemic than when they were diagnosed, Andersen said. In particular, lung cancer patients had a much lower rate of clinical depression, about 12%, than the control group, 28%. Anxiety results also showed similarly significant differences.
Overall, patients expressed significantly less stress about COVID-19, less worry about their family testing positive for the coronavirus and greater success with social distancing compared with the controls without cancer.
That’s not to say patients had zero concern for the pandemic. They were moderately concerned about their lung cancer, Andersen said. But compared with the control group, they were concerned about their overall health to a similar degree, which suggests that they regarded COVID-19 within the larger context of their other health concerns.
“For these patients, COVID occurred in the midst of an ongoing life-threatening disease, cancer-related symptoms and routines already disrupted by receiving treatment. The pandemic was just another challenge to overcome,” Andersen said. “But for the group without chronic conditions, COVID was an unexpected source of stress and made them worry about their health in a way they weren’t used to.”
Despite these encouraging results, Andersen emphasized that depression and anxiety do affect lung cancer patients. Health care providers should continue to screen for these issues and refer patients to psychological treatment when needed.
Andersen said this study has brought to light another message. “It is a message of strength and resilience, of being able to persevere despite all the challenges. These lung cancer patients showed incredible toughness during COVID and went about what they had to do and continued their treatment, despite their very difficult disease.”
To read more about living well with lung cancer, see “Finding Grace in Adversity.”