Cancer survivors’ perceived vulnerability to COVID-19 and impacts on cognitive, affective, and behavioral responses to the pandemic

Abstract

Study objectives

Given the uncertainty COVID-19 has caused for individuals with prior medical conditions, we examined the extent to which cancer survivors consider themselves at risk for the global COVID-19 pandemic (henceforth COVID), both in general and due to their cancer history. Additionally, we evaluated whether perceived vulnerability to COVID among cancer survivors predicts their cognitive/affective and behavioral responses to the pandemic.

Design/sample

Cancer survivors who completed primary cancer treatment (median months since treatment = 33.00) and were enrolled in prior behavioral trials with our research team (N = 146) completed two surveys in May-July 2020 (95.89% retention).

Methods

Participants rated perceived next-year risk of infection and of dying from COVID. We adapted established scales to assess perceived vulnerability to COVID generally versus as a cancer survivor, catastrophizing about possible COVID symptoms, COVID-related contamination fears, and adherence to COVID prevention behaviors.

Findings

In May 2020, on a 1-100 scale with 0 = no chance and 100 = definitely will occur, cancer survivors reported a chance in the next year of contracting COVID of M = 39.94 (SD = 23.90), and dying from COVID of M = 24.46 (SD = 24.84). Cancer survivors reported somewhat greater vulnerability to COVID compared to same-aged peers, increased contamination fears, and high adherence to COVID prevention measures. Similar findings emerged six weeks later, suggesting stability over time. In simple linear regression models, both general and cancer survivor-specific perceived COVID vulnerability predicted COVID symptom catastrophizing and contamination fears; in multivariable models, only general vulnerability remained a significant predictor. General perceived vulnerability and contamination fears predicted greater adherence to COVID prevention behaviors.

Conclusions

Cancer survivors perceived elevated vulnerability to COVID even years after treatment, which predicted adherence to COVID prevention behaviors. Future research should identify the optimal balance between supporting cancer survivors’ concerns and minimizing negative impacts on quality of life.

Keywords:

• Anxiety
• cancer
• cancer survivorship
• contamination
• coronavirus
• COVID-19

Disclosure statement

The authors declare that they have no conflict of interest.

Data availability statement

Data are not publicly available online at this time, as additional data are still being collected. Please contact the authors with questions or requests regarding the data.

Data deposition

Not applicable at this time.

Notes

1 Anxiety sensitivity refers to the catastrophic misinterpretation of arousal-related bodily sensations (Abramowitz et al., 2007). Here, we adjust this concept in two ways: we focus on not only arousal-related bodily sensations but also sensations related to breathing and body temperature, and we use COVID infection as the specific catastrophe.

2 Four participants were lost to follow-up. In addition, we did not administer the second survey to two participants: one only partially completed the first questionnaire, though completed all measures relevant to the current study, and a second completed the first survey too late to be included in the second survey.

Additional information

Funding

J.J.A. was supported by the National Institutes of Health (NIH; R21CA218723; R01NR018479) and S.J.S. was supported by the NIH (R01NR018479) in preparing this manuscript.