Impact of the COVID-19 pandemic on quality of life and emotional wellbeing in patients with bone metastases treated with radiotherapy: a prospective cohort study

Clinical & Experimental Metastasis https://doi.org/10.1007/s10585-021-10079-x RESEARCH PAPER Impact of the COVID‑19 pandemic on quality of life and emotional wellbeing in patients with bone metastases treated with radiotherapy: a prospective cohort study M. M. T. J. Bartels1 · R. Gal1 · J. M. van der Velden2 · J. J. C. Verhoeff2 · J. J. Verlaan3 · H. M. Verkooijen1 Received: 11 January 2021 / Accepted: 11 February 2021 © The Author(s) 2021 Abstract Implementation of COVID-19 measures may have induced concerns about access and quality of health care for cancer patients with bone metastases, and it may have affected their quality of life. In this study, we evaluated the effect of the first COVID-19 lockdown on quality of life and emotional functioning of patients with stage IV cancer treated for painful bone metastases in the UMC Utrecht, the Netherlands. A COVID-19 specific questionnaire was sent to active participants in the Prospective Evaluation of interventional StudiEs on boNe meTastases (PRESENT) cohort, consisting of patients irradiated for metastatic bone disease. Patient reported outcomes (PROs) were compared with the last two PROs collected within the PRESENT cohort before the COVID-19 lockdown in the Netherlands on the 16th of March. For the 169 (53%) responders, median age at start of lockdown was 68 years (range 38–92) and 62% were male. Patients reported a statistically significant decrease in emotional functioning (83.6 to 79.2, P = 0.004) and in general quality of life score during the COVID-19 lockdown (72.4 to 68.7, P = 0.007). A steep increase in feeling isolated was reported (18% before and 67% during lockdown). This study has shown a strong increase in the experience of isolation and a decrease of emotional functioning and general quality of life during the COVID-19 lockdown in cancer patients with bone metastases. Due to the nature of the treatment of this patient population, efforts should be made to minimize these changes during future lockdowns. Keywords COVID-19 · Pandemic · Quality of life · Patient reported outcomes · Metastasis · Radiation oncology · Palliative care · Social isolation · PRESENT-study Abbreviations PROs Patient reported outcomes PRESENT Prospective evaluation of interventional StudiEs on boNe meTastases UMCU University Medical Center Utrecht BPI Brief pain inventory EORTC European Organisation for Research and Treatment of Cancer * M. M. T. J. Bartels 1 Division of Imaging and Oncology, Trial Office, University Medical Center Utrecht, Heidelberglaan 100, Internal mail Q.00.311, 3584 CX Utrecht, The Netherlands 2 Division of Imaging and Oncology, Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands 3 Division of Surgical Specialties, Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands DL During lockdown—timpoint during lockdown BL-1 Before lockdown 1—first timepoint before start of lockdown BL-2 Before lockdown 2—second timepoint before start of lockdown M Mean SD Standard deviation IQR Inter quartile range SPSS Statistical Package for Social Sciences Introduction On March 16th 2020, the first official lockdown was announced in the Netherlands as a reaction on the outbreak of the SARS CoV-2 pandemic. Other emergency measures taken included the use of medical and non-medical facemasks, social distancing and targeted quarantine. [1] The lockdown influenced many aspects of oncology care. [2–7] 13 Vol.:(0123456789) Clinical & Experimental Metastasis To accommodate the increasing pressure on the health care system in The Netherlands, elective health care was postponed as much as possible. This included postponement of most oncologic care to minimize infection risk, as cancer patients are considered a high-risk patient population that would suffer severe complications when infected with SARS-CoV-2. [3, 4] Therefore, national and local oncological health care protocols were modified to minimise the risk of transmission of the virus and maximize capacity for COVID-19 care. [8] This unprecedented situation is expected to have impacted the life of many patients with metastasized cancer: implementation of the COVID-19 measures may have induced concerns about their (access) to treatment and continuity of health care. [9] In addition, measures of social distancing may have incapacitated caregiver support networks and informal care schedules. [10] Since this palliative patient population may not have the opportunity to catch up on lost time after the pandemic has stabilized, mental health and emotional functioning may have been seriously affected as well. In this study, we evaluated the effect of societal COVID-19 measures on changes in quality of life and emotional functioning of patients with metastatic bone disease. Methods Study design and participants The current study was conducted within the Prospective Evaluation of interventional StudiEs on boNe meTastases (PRESENT) cohort. [11] The PRESENT cohort includes patients with bone metastases, referred to the Department of Radiation Oncology of the University Medical Center Utrecht (UMCU) in the Netherlands. Patients are invited to participate in PRESENT prior to their appointment with the radiation oncologist. Patients consented to longitudinal collection of clinical data through medical records, and for receiving questionnaires at regular intervals during and after radiation treatment. The questionnaires consisted of: Brief Pain Inventory (BPI), European Organisation for Research and Treatment of Cancer quality of life questionnaires (EORTC-C15-PAL and EORTC-BM22) and the EuroQoL five-dimensional instrument of health-related quality of life (EQ5D-3L). [11–14] The PRESENT-study was approved by the Medical Ethics Committee of the UMCU (NL49273.041.14, METC 13/261) and was registered on clinicaltrials.gov (NCT02356497). For the current study, an additional COVID-19 specific questionnaire was sent out to active PRESENT cohort patients who had given informed consent to receive quality of life questionnaires. This questionnaire was approved as an addendum to the PRESENT study by the Medical Ethics Committee of the UMCU, and 13 consisted of selected questions from the BPI, EORTC-C15PAL and EORTC-BM22 questionnaires, as well as questions developed by the study team to evaluate the impact of COVID-19 measures on health care. Data collection On the 7th of April 2020, the additional online questionnaire was sent out to active PRESENT cohort participants, shortly after the start of the national COVID-19 (partial and “intelligent”) lockdown on the 16th of March. Patient reported outcomes (PROs) within two years before the start and during the COVID-19 lockdown (either collected with the specific COVID-19 questionnaire or through regular follow up cohort questionnaires) from individual patients were included. 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