Survey Explores Mental Health of Patients With NSCLC During COVID-19

Non-small cell lung cancer (NSCLC) patients reported superior mental health well-being during the COVID-19 pandemic compared to a cancer-free control population.

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

The study, published in Journal of the National Comprehensive Cancer Networkrevealed that these patients had less depression and anxiety than their healthy peers, despite having to leave home regularly for treatment.

Lung cancer patients are vulnerable to coronavirus pneumonias and acute respiratory distress syndrome, and if they become infected, they are at increased risk of dying from these complications, the authors explained. Furthermore, in the United States, lung cancer deaths account for “25% more cancer deaths than deaths from prostate, breast, and colon cancer combined, in part because 84% of lung cancer patients are diagnosed at an advanced stage.

To compare patients’ psychological responses at diagnosis and during COVID-19, and to compare their coping responses to cancer-free controls from the same community, the 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 Questionnaire-9 (PQH-9), and General Anxiety Disorder Questionnaire-7 (GAD-7) using Qualtrics.

Those with NSCLC had a mean age of 62.6 years, were 40.8% female, 80.3% white, and the majority of tumors were adenocarcinoma (77.6%).

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The analyzes revealed:

  • Depressive and anxious symptoms of NSCLC patients were higher at diagnosis (P < .02) than during COVID-19, approximately 1 year later
  • Patients and controls did not differ with respect to perceived concern, understanding, or control over COVID-19 (P > .406)
  • NSCLC patients 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 = .023) than controls, after controlling for race, age, and smoking status
  • The controls anticipated that the threat of COVID-19 would last longer, they practiced more social distancing, they were more concerned about the family (P .04), and reported worse psychological symptomatology (P < .023) than patients
  • For controls, COVID-19 was more salient (i.e., novel, 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 especially susceptible to COVID-19 infection and death, are emotionally and behaviorally capable of traveling to the hospital and receive treatment, monthly if not. weekly,” the researchers noted.

Before conducting the study, some investigators hypothesized that patients’ PHQ-9 and GAD-7 scores would be elevated. These notions were shown to be incorrect, as the authors described patients’ resilience in the face of the pandemic, defining the term as “adapting well in the face of adversity, trauma, tragedy, threats, or significant stress.”

One possible explanation for the divergence in responses could be the fact that “COVID-19 for NSCLC patients occurred amid constant threat to life, comorbidities, symptoms, and routines already disrupted by receiving cancer treatment,” they wrote. the authors.

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


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


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