Laura is the editorial director of The American Journal of Managed Care® (AJMC®) and all its brands, including The American Journal of Accountable Care®, Evidence-Based Oncology™, and The Center for Biosimilars®. She has been working on AJMC® since 2014 and has been with AJMC®'s parent company, MJH Life Sciences, since 2011. She has an MA in business and economic reporting from New York University.
As people socially distanced during the COVID-19 pandemic, the problems of loneliness and social isolation were exacerbated.
During the pandemic, as more people socially distanced, the problems of loneliness and social isolation were exacerbated. Even before the COVID-19 pandemic, these issues were gaining recognition as significant public health issues.
“Patients with cancer, as well as survivors, need to realize that feelings of loneliness and social isolation are very common during the COVID-19 pandemic,” lead author Christine Miaskowski, RN, PhD, FAAN, of the University of California, San Francisco, said in a statement. “In addition to this sense of loneliness, they may be having feelings of anxiety, sadness, and fatigue, as well as problems sleeping and high rates of unrelieved pain—all at the same time.”
Miaskowski and colleagues sought to determine the prevalence of loneliness among patients with cancer, evaluate differences between lonely and nonlonely people, and determine what characteristics were associated with loneliness. They recruited patients from the Dr. Susan Love Foundation for Breast Cancer Research and a registry of individuals who participated in their previous studies funded by the National Cancer Institute.
Potential participants received emails to participate beginning May 27, 2020, with an email reminder sent 14 days after the initial request. A total of 606 patients completed the survey and 53.0% were classified as lonely based on their responses.
The lonely group was significantly younger (61.4 vs 64.3 years), less likely to be married or partnered (62.0% vs 76.8%), and more likely to live alone (28.5% vs 18.2%) compared with the nonlonely group. Patients in the lonely group also had a lower household income, with 49.8% of patients reporting their household income was greater than $100,000 compared with 64.7% of patients in the nonlonely group.
The lonely group had a higher number of comorbidities (2.1 vs 1.6) and was more likely to self-report depression (38.1% vs 13.0%) and back pain (36.8% vs 28.6%). Lonely patients also had significantly lower Karnofsky Performance Status (KPS) scores (93.1 for the nonlonely group vs 90.5 for the lonely group). The KPS scale assess functional impairment, and it can be used to compare the effectiveness of different therapies and assesses the prognosis of individual patients. A lower KPS score means a worse likelihood of survival.
More than a third of patients (35.8%) reported a moderately high degree of loneliness and 50.3% reported high degrees of loneliness. According to the authors, before the pandemic, loneliness rates for patients with cancer were between 32% and 47%.
“These findings suggest that like the general US population, a high percentage of oncology patients are experiencing significant levels of loneliness during COVID-19 that exceed previous benchmarks,” the authors wrote.
The authors noted some limitations to their findings. Because 91.8% of the respondents were female, they could not draw any conclusions about sex differences. In addition, patients were overall White, well educated, and reported an annual income above $60,000.
“Given the racial/ethnic disparities associated with the COVID-19 pandemic, we hypothesize that the high symptom burden reported by the patients in our study will be higher in patients who are socioeconomically disadvantaged,” said Miaskowski.
Miaskowski C, Paul SM, Snowberg K, et al. Loneliness and symptom burden in oncology patients during the COVID-19 pandemic. Cancer. Published online April 27, 2021. doi:10.1002/cncr.33603