Cancer Patients Lonely and Depressed During COVID-19 Pandemic

Loneliness and social isolation have been significant problems for the general population during the COVID-19 pandemic, but for cancer patients these issues were particularly acute, likely due to isolation and social distancing, according to a new UC San Francisco study.

The study, which is the first to evaluate loneliness, anxiety, depression, fatigue and other symptoms in a single group of patients, is published in Cancer, a peer-reviewed journal of the American Cancer Society.  

“We found that oncology patients were experiencing a deep sense of loneliness,” said first author Christine Miaskowski, RN, PhD, a professor in the UCSF School of Nursing.

“For these patients, the burden of their symptoms is extremely high, and oncology clinicians can suggest a number of strategies to help them,” she said. “Patients should be encouraged to maintain contact with family and friends, and structure their daily routines when possible, through outdoor activities for example, as well as to maintain a healthy diet and sufficient sleep. These suggestions might mitigate some of the negative effects of loneliness.” 

The COVID-19 pandemic brought to the forefront a pervasive sense of loneliness in the lay population, but the effects have not been well studied in oncology patients. The new survey, administered in late May 2020, evaluated the severity of loneliness, social isolation and related symptoms – such as anxiety, depression, fatigue, sleep disturbance, cognitive dysfunction and pain – in a sample of 606 oncology patients.

Altogether, 53 percent were found to be in the lonely group, which was higher than the range reported prior to the pandemic (32 percent - 47 percent). About a third had moderately high degrees of loneliness, and 5.3 percent reported high levels of depression.

The lonely group was significantly more likely to be younger than the non-lonely group and less likely to be married or partnered. They also had a higher number of comorbidities and were more likely to report a diagnosis of depression and back pain.

Older cancer patients reported lower levels of loneliness, while patients 50 to 59 reported higher levels. The researchers believe older adults adapted their need for social contact to available opportunities.

Lower levels of household income were associated with higher levels of loneliness. The authors suggest that people at higher incomes have “more opportunities to engage in social activities and reciprocate in social relationships.”

Nearly 83 percent of the patients in the lonely group suffered from breast cancer, a third were currently in cancer treatment and a quarter had metastatic disease. Nearly 92 percent of the participants were female – as a result, no conclusions could be drawn about sex differences, the authors said.

Primarily, the participants were white, well-educated, and had an annual income exceeding $60,000. As such, the authors said, their findings may not fit all patients with cancer, and symptoms could be higher in patients who are socioeconomically disadvantaged.

Authors: Additional UCSF authors include Steven M. Paul, PhD; Karen Snowberg, MA; Hala Borno, MD; Susan M. Chang, MD; Lee May Chen, MD; Bruce A. Cooper, PhD; Stacey A. Kenfield, ScD; Kord M. Kober, PhD; Angela Laffan, MS, NP; Jon D. Levine, MD, PhD; Kim Rhoads, MD, MPH; Katy K. Tsai, MD; Erin L. Van Blarigan, ScD; and Katherine Van Loon, MD, MPH.

Funding: Miaskowski is an American Cancer Society Clinical Research Professor. Van Blarigan is funded by the National Institutes of Health (CA197077). Additional funding sources can be found in the paper.

UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is ranked among the top 10 hospitals nationwide, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland, Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area.