Stressors related to the COVID-19 pandemic and their association with distress, depressive, and anxiety symptoms in cancer out-patients

Tamara Frank; Theresia Pichler; Sabrina Maier; Ineke Batenhorst; Tanja Abawi; Nadia Harbeck; Hana Algül; Volker Heinemann; Kerstin Hermelink; Friederike Mumm; Andreas Dinkel

doi:10.3389/fpsyg.2023.1100236

Stressors related to the COVID-19 pandemic and their association with distress, depressive, and anxiety symptoms in cancer out-patients

Front Psychol. 2023 Jun 2:14:1100236. doi: 10.3389/fpsyg.2023.1100236. eCollection 2023.

Authors

Tamara Frank^{1

2}, Theresia Pichler¹, Sabrina Maier¹, Ineke Batenhorst¹, Tanja Abawi², Nadia Harbeck^{1

3}, Hana Algül^{1

4}, Volker Heinemann^{1

5}, Kerstin Hermelink³, Friederike Mumm^{1

5}, Andreas Dinkel²

Affiliations

¹ Comprehensive Cancer Center Munich, Munich, Germany.
² Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
³ Department of Obstetrics and Gynecology, LMU University Hospital, Munich, Germany.
⁴ Mildred-Scheel-Professor of Tumor Metabolism, Technical University of Munich, Munich, Germany.
⁵ Department of Internal Medicine III, LMU University Hospital, Munich, Germany.

Abstract

Patients with cancer might be particularly prone to stress caused by the COVID-19 pandemic. The aim of this study was to investigate the impact of pandemic-related stressors on oncological patients' psychological well-being. During the second wave of the COVID-19 pandemic in Germany 122 cancer out-patients of the Comprehensive Cancer Center Munich reported on COVID-19-related stressors (information satisfaction, threat perception, and fear of disease deterioration) and answered standardized questionnaires for psychosocial distress (DT) as well as depression and anxiety symptoms (PHQ-2, GAD-2). Multiple linear regression analyses were used to identify associations of the COVID-19-related stressors with psychological symptoms, controlling for sociodemographic, psychological (self-efficacy, ASKU) and clinical (somatic symptom burden, SSS-8) variables. Initially, satisfaction with information was significantly negatively associated with all three outcome variables. Fear of disease deterioration was associated with distress and depressive symptoms. After controlling for additional variables, only satisfaction with information remained an independent determinant of anxiety (β = -0.35, p < 0.001). All three outcomes were most strongly determined by somatic symptom burden (β ≥ 0.40, p < 0.001). The results of this study tentatively suggest that physical well-being overrides the relevance of some COVID-19-related stressors for oncological patients' psychological wellbeing. Physical symptoms are strongly tied to personal wellbeing as they are associated with suffering from cancer, which might be more central to personal wellbeing than the possibility of getting infected with SARS-CoV-2. However, satisfaction with the information received seems to be important beyond physical wellbeing, as this emerged as an independent determinant of anxiety.

Keywords: COVID-19; anxiety; cancer; coronavirus; depression; distress; somatic symptoms; stressors.