Survey explores mental health of NSCLC patients during COVID-19


Patients with non-small cell lung cancer (NSCLC) reported higher mental health well-being during the COVID-19 pandemic compared to a control population that did not have cancer.

Cancer patients may be more resilient to COVID-19-related stressors, according to new research that showed those with advanced non-small cell breakfast cancer (NSCLC) coped better with the pandemic than many of their peers who did not have cancer.

The study, published in Journal of the National Comprehensive Cancer Networkfound that these patients had less depression and anxiety than their healthy peers, even though they regularly had to leave their homes to receive treatment.

Lung cancer patients are vulnerable to coronaviral pneumonia and acute respiratory distress syndrome, and if infected, they are at greater risk of dying from these complications, the authors explained. Additionally, in the United States, lung cancer deaths are “25% more cancer deaths than prostate, breast, and colon cancer deaths combined, in part because 84% of patients with ‘lung cancer are diagnosed at an advanced stage’.

To compare patients’ psychological responses at diagnosis and those during COVID-19, and to compare their coping responses with cancer-free controls from the same community, researchers analyzed data collected in Ohio between April and July 2020.

All patients (N = 76) had stage IV NSCLC, and 67 controls with similar sociodemographic information and smoking history were recruited. Participants completed the online Brief Illness Perception Questionnaire, Patient Health Questionaire-9 (PQH-9), and General Anxiety Disorder-7 (GAD-7) using Qualtrics.

People with NSCLC had a mean age of 62.6 years, were 40.8% female, 80.3% white, and most tumors were adenocarcinomas (77.6%).

The analyzes revealed:

  • Depressive and anxiety symptoms in patients with NSCLC were greater at diagnosis (P
  • Patients and controls did not differ in worrying, understanding, or perceived control over COVID-19 (P > .406)
  • Patients with NSCLC reported significantly less depression (β = -0.206; 95% CI, -4.142 to -0.355; P = 0.020) and anxiety symptoms (β = −0.196; 95% CI, -4.037 to -0.308; P = 0.023) than controls, after controlling for racial group, age, and smoking status
  • Controls predicted the COVID-19 threat would last longer, practiced more social distancing, were more concerned about family (P .04), and reported more severe psychological symptoms (P
  • For witnesses, COVID-19 was more salient (i.e. new, unexpected), increasing concerns and psychological symptoms

“It is important to understand and appreciate how NSCLC patients with the most severe disease burden and symptom severity – those who are particularly susceptible to infection and death from COVID-19 – are emotionally and behaviorally able to attend the hospital and receive treatment, monthly if not weekly,” the researchers noted.

Before conducting the study, some researchers speculated that the patients’ PHQ-9 and GAD-7 scores would be elevated. These notions turned out to be wrong, as the authors described patient resilience in the face of the pandemic, defining the term as “coping well in the face of adversity, trauma, tragedy, threats, or significant stress.” .

A potential explanation for the discrepancy in responses could be that “COVID-19 for NSCLC patients occurred amidst life-threatening, co-morbidities, symptoms, and routines already disrupted by treatment against cancer,” the authors wrote.

However, they emphasized the importance of using the measures recommended by the American Society of Clinical Oncology for depression and anxiety at diagnosis and thereafter for patients with NSCLC.


Arrato NA, Lo SB, Coker CA, et al. Cancer treatment during COVID-19: resilience of people with advanced non-small cell lung cancer compared to community controls. J Natl Compr Canc Netw. Published online February 2022. doi:10.6004/jnccn.2021.7076


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