Oncologists underestimate patients’ motivation to attend appointments during COVID-19 pandemic

Oncologists underestimate patients’ willingness to attend appointments to avoid treatment interruptions during the COVID-19 pandemic, according to a multidisciplinary cross-sectional survey, which shows unaltered willingness to attend scheduled appointments in most cancer patients.

The COVID-19 pandemic has caused unprecedented disruptions to cancer care worldwide. To examine the real-world impact of the COVID-19 pandemic from patients’ perspectives, 650 cancer patients were surveyed on 12–22 May 2020 at Queen Elizabeth Hospital (QEH) using a 64-item questionnaire developed by a multidisciplinary panel. [Hong Kong Med J 2023;29:132-141]

A total of 424 patients (female, 70.0 percent; aged 46–75 years, 80.0 percent; receiving active cancer treatment, 46.0 percent) responded to the survey, yielding a response rate of 65.2 percent. The researchers also surveyed 21 clinical oncologists in QEH, United Christian Hospital and Buddhist Hospital to evaluate their perception of patients’ healthcare-seeking behaviour during the pandemic.

Most surveyed patients believed that cancer patients are more susceptible to COVID-19 (82.8 percent) and hospital attendance was unsafe during the pandemic (69.1 percent). Despite the perceived risk, most respondents expressed unaltered willingness to attend oncology clinic appointments (73.1 percent) and undergo clinical tests (80.2 percent). More than 80 percent (83.3 percent) of respondents believed that increasing physical distance between medical staff and patients did not negatively impact the quality of their clinic experience.

In addition, most patients reported that they preferred to receive chemotherapy (70.3 percent) or radiotherapy (67.9 percent) as planned during the pandemic. Nearly half (46.5 percent) were willing to accept changes in efficacy or side effect profile to allow an outpatient regimen, and this preference was stronger in patients receiving palliative treatment vs those receiving radical treatment (61.5 percent vs 31.7 percent). If requested by their oncologists, half of the patients (62.2 percent) were willing to be hospitalized, especially male patients and those receiving radical treatment.

In contrast, all surveyed oncologists predicted a marked reduction in patients’ willingness to attend clinic appointments and to be hospitalized, indicating a tendency to underestimate patients’ motivation to avoid treatment interruptions and patients’ risk acceptance.

“The study revealed a discrepancy between male and female cancer patients in terms of healthcare-seeking behaviour,” noted the researchers. “Patients receiving radical treatment demonstrated different perceptions and needs compared with patients receiving palliative care.”

“The sustained clinical demands, along with patients’ acceptance of COVID-19 adaptive measures [eg, medical staff–patient distancing], streamlined service [prescription-only clinics] and outcome trade-offs [ie, efficacy and side effect profile], allow oncology services to continue with minimal disruptions,” pointed out the researchers.

Telerehabilitation could be a promising alternative for patient-clinician interactions during the pandemic. “However, our findings revealed that it may not be universally welcomed, particularly among older patients and those with low socioeconomic status,” the researchers noted. They therefore suggested triaging appropriate patients towards telemedicine and enhancing general telehealth literacy through implementation of user-friendly interfaces, step-by-step demonstrations and support hotlines.

Results of the survey raise awareness of pandemic-related effects on cancer patients, revealing their priorities and unmet needs. To enable appropriate resource allocation, oncology healthcare providers should consider the unique needs of various patient groups when implementing pandemic-related management strategies.