The Effect of COVID-19 on Radiation Oncology Professionals and Patients With Cancer: From Trauma to Psychological Growth

Abstract

The outbreak of severe acute respiratory syndrome coronavirus-2 and the coronavirus disease 2019 (COVID-19) pandemic represent an international public health emergency.1Meattini I. Franco P. Belgioia L. et al.Radiation therapy during coronavirus disease 2019 (covid-19) pandemic in Italy: A view of the nation's young oncologists.ESMO Open. 2020; 5: e000779Crossref PubMed Scopus (41) Google Scholar Patients with cancer are at higher risk of developing severe COVID-19 manifestations and hence the whole clinical decision-making process for oncological care is being revised, to balance the risk–benefit ratio for each treatment offered to patients.2Romesser P.B. Wu A.J. Cercek A. et al.Management of locally advanced rectal cancer during the COVID-19 pandemic: A necessary paradigm change at Memorial Sloan Kettering Cancer Center.Adv Rad Oncol. 2020; 5: 687-689Abstract Full Text Full Text PDF Scopus (28) Google Scholar, 3Wu A.J. Rimner A. 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De Santis M.C. et al.Omission of postoperative radiation after breast conserving surgery: A progressive paradigm shift towards precision medicine.Clin Transl Oncol. 2020; 21: 112-119Scopus (25) Google Scholar This scenario forces health care providers, including radiation therapy professionals, to undergo substantial reorganization in terms of staffing, resources, working processes, treatment allocation, and delivery and safety measures.7Filippi AR, Russi E, Magrini SM, Corvò R. Covid-19 outbreak in Northern Italy: First practical indications for radiotherapy departments [epub ahead of print]. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2020.03.007. Accessed May 5, 2020.Google Scholar,8Simcock R, Thomas TV, Estes C, et al. COVID-10: Global radiation oncology's targeted response for pandemic preparedness [epub ahead of print]. Clin Transl Oncol. https://doi.org/10.1016/j.ctro.2020.03.009. Accessed May 5, 2020.Google Scholar This situation is supposed to have practical and psychological consequences for both patients with cancer and healthcare workers. This is even magnified on a personal level because the response required by the COVID-19 pandemic calls for draconian measures (quarantine for entire communities, social isolation), which are a potential source of further distress.9Shanafelt T, Jonathan R, Mickey T. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic [epub ahead of print]. JAMA. https://doi.org/10.1001/jama.2020.5893. Accessed May 5, 2020.Google Scholar,10Sindhu K.K. Gupta V. Fear in the age of COVID-19 [epub ahead of print].Adv Rad Oncol. 2020; 5: 525-526Abstract Full Text Full Text PDF Scopus (8) Google Scholar Individuals facing traumatic events usually experience distressing emotions such as anxiety, sadness, guilt, and anger. For healthcare providers, an important stressor is related to the fear of being exposed to severe acute respiratory syndrome coronavirus-2 at hospital and the consequent anxiety of bringing the infection home.9Shanafelt T, Jonathan R, Mickey T. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic [epub ahead of print]. JAMA. https://doi.org/10.1001/jama.2020.5893. Accessed May 5, 2020.Google Scholar For patients with cancer, the fear of being infected adds to the cancer condition, which represents per se a traumatic event. Exposure to trauma is usually associated to psychological distress and trauma- and stressor-related disorders such as posttraumatic stress disorder. High levels of posttraumatic stress disorder were observed among medical staff during the H7N9 avian flu outbreak.11Tang L. Pan L. Yuan L. Zha L. Prevalence and related factors of post-traumatic stress disorder among medical staff members exposed to H7N9 patients.Int J Nurs Sci. 2016; 4: 63-67PubMed Google Scholar Nevertheless, the presence of negative consequences in the aftermath of the trauma does not exclude the possibility of developing positive outcomes thereafter.12Romeo A. Di Tella M. Ghiggia A. Tesio V. Torta R. Castelli L. Posttraumatic growth in breast cancer survivors: Are depressive symptoms really negative predictors?.Psychol Trauma. 2020; 12: 244-250Crossref PubMed Scopus (18) Google Scholar,13Shakespeare-Finch J. Lurie-Beck J. A meta-analytic clarification of the relationship between posttraumatic growth and symptoms of posttraumatic distress disorder.J Anxiety Disord. 2014; 28: 223-229Crossref PubMed Scopus (325) Google Scholar Indeed, trauma can be a fertile ground for an unexpected outcome observed in survivors: posttraumatic growth (PTG). PTG refers to "positive psychological change experienced as a result of the struggle with highly challenging life circumstances."14Tedeschi R.G. Calhoun L.G. Posttraumatic growth: Conceptual foundations and empirical evidence.Psychol Inquiry. 2004; 15: 1-18Crossref Scopus (3968) Google Scholar The Posttraumatic Growth Inventory is the most reliable measure to evaluate the positive change following a traumatic event. It measures 5 domains: (1) appreciation of life, (2) intimate relationships with others, (3) sense of personal strength, (4) recognition of new possibilities, and (e) spiritual change.15Tedeschi R.G. Calhoun L.G. The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma.J Trauma Stress. 1996; 9: 455-471Crossref PubMed Scopus (4220) Google Scholar Growth, however, does not occur as a direct result of trauma. Different factors could foster the development of PTG. They are related to sociodemographic features such as age (higher growth for younger individuals), personality characteristics (extraversion, open-mindedness to experience), and coping strategies to manage distressing emotions. Also crucial is the activation of a cognitive processing allowing individuals to disengage with previous core beliefs and to build new schemas and meanings. Eventually, the presence of social support can help in elaborating narratives about the traumatic event experienced.14Tedeschi R.G. Calhoun L.G. Posttraumatic growth: Conceptual foundations and empirical evidence.Psychol Inquiry. 2004; 15: 1-18Crossref Scopus (3968) Google Scholar In conclusion, traumatic and stressful events, like the COVID-19 pandemic, have definitely negative acute effects, but can lead to mid- to long-term positive outcomes. Hence, both healthcare providers and patients with cancer should be supported whenever experiencing psychological distress or difficulties in changing personal cognitive beliefs or struggling as a result of a lack of social help. This is important to foster the process of positive growth.

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