The impact of negative COVID-19 experiences on cancer survivors' health-related quality of life and psychological distress: a moderated mediation model

Blanca S Noriega Esquives; Akina Natori; Michael H Antoni; Amy K Otto; Sarah Prinsloo; Richard W Wagner; Telma I Gomez; Cassandra A Hathaway; Cornelia M Ulrich; Anita R Peoples; Lorenzo Cohen; Frank J Penedo

doi:10.3389/fpsyg.2024.1423106

The impact of negative COVID-19 experiences on cancer survivors' health-related quality of life and psychological distress: a moderated mediation model

Front Psychol. 2024 Sep 12:15:1423106. doi: 10.3389/fpsyg.2024.1423106. eCollection 2024.

Authors

Blanca S Noriega Esquives^#¹, Akina Natori^#², Michael H Antoni^{1

3}, Amy K Otto⁴, Sarah Prinsloo^{5

6}, Richard W Wagner⁵, Telma I Gomez⁷, Cassandra A Hathaway⁸, Cornelia M Ulrich^{9

10}, Anita R Peoples⁹, Lorenzo Cohen⁵, Frank J Penedo^{1

11

12}

Affiliations

¹ Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States.
² Division of Medical Oncology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States.
³ Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States.
⁴ University of Minnesota Medical School, Duluth, MN, United States.
⁵ Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States.
⁶ Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States.
⁷ Department of Pediatrics Hematology-Oncology, Baylor College of Medicine, Houston, TX, United States.
⁸ Westat, Rockville, MD, United States.
⁹ Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States.
¹⁰ Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States.
¹¹ Department of Psychology, University of Miami, Miami, FL, United States.
¹² Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States.

^# Contributed equally.

Abstract

Introduction: Cancer survivors experienced poorer health-related quality of life (HRQoL) and greater psychological distress during the COVID-19 pandemic than those without cancer. However, the underlying mechanisms that may explain how negative experiences during the pandemic are associated with distress and HRQoL remain unknown. We examined whether psychosocial risk factors (i.e., healthcare disruption, disruption to daily activities and social interaction [DDASI], and financial hardship) mediated the relationship between negative COVID-19-related experiences and cancer survivors' HRQoL and psychological distress (i.e., depressive symptoms, and anxiety) and whether the mediating effects were moderated by psychosocial protective factors (i.e., stress management ability and social support).

Methods: A total of 9,651 cancer survivors completed a questionnaire assessing negative COVID-19-related experiences, psychosocial and practical experiences, and HRQoL. Conditional process analysis was used to evaluate the proposed moderated mediation models.

Results: Participants had a mean age of 63.8 years (SD = 12.3) and were mostly non-Hispanic White (82.3%). DDASI and financial hardship mediated the relationship between negative COVID-19-related experiences and cancer survivor's HRQoL and psychological distress. Stress management ability buffered the indirect effect of DDASI on cancer survivors' HRQoL and psychological distress. Social support buffered the indirect effect of financial hardship on HRQoL and depressive symptoms.

Conclusion: Financial resources and social interactions may buffer negative effects of major disruptions such as the COVID-19 pandemic. Future studies should assess the longitudinal impact of these associations.

Keywords: COVID-19 pandemic; cancer survivors; financial hardship; health-related quality of life; moderated mediation analysis; psychological distress.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported in part by the National Institutes of Health (NIH) through University of Miami Sylvester Comprehensive Cancer Center’s Cancer Center Support Grant P30CA240139 and MD Anderson’s Cancer Center Support Grant P30CA016672, the Duncan Family Institute for Cancer Prevention and Risk Assessment, and the Richard E. Haynes Distinguished Professorship for Clinical Cancer Prevention at The University of Texas MD Anderson Cancer Center (L. Cohen). Blanca Noriega Esquives was supported by grant T32CA251064 (Penedo F. J. and Kobetz, E. MPIs). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.