Psychological distress in outpatients with lymphoma during the covid-19 pandemic

Background: Cancer patients are a population at high risk of contracting COVID-19 and, also of developing severe complications due to the infection, which is especially true when they are undergoing immunosuppressive treatment. Despite this, they had still to go to hospital to receive chemotherapy during lockdown. Aims: In this context, we have evaluated the psychological status of onco-hematological outpatients receiving infusion and not deferrable anti-neoplastic treatment for lymphoproliferative neoplasms, with the aim of both measuring the levels of post-traumatic symptoms, depression, and anxiety during the pandemic and also of investigating the perception of risk of potential nosocomial infection. Methods: The Impact of Event Scale-Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS) were administered to all patients. Moreover, patients were investigated about their worries regarding the impact of COVID-19 on their lives as onco-hematologic patients. Since the 2nd to the 29th April 2020 (during the first phase of the lockdown period in Italy) outpatients affected by lymphoma and needing an infusional chemotherapy/ immunetherapy were evaluated in the study. A multi-disciplinary approach to the patient was then activated, in order to provide a psychological support during the next phases of pandemy. Results: 77 outpatients were prospectively evaluated. The mean age was 56.6 (range 22-85);39 (50.6 %) were male and 38 (49.4 %) female. Diagnoses were distributed as: cHL n. 25 (32.5%);aggressive NHLS n. 15 (19.5%), of whom n. 9 had diffuse large B-cell lymphoma (DLBCL), n 5 mantle cell lymphoma (MCL), and n. 1 primary mediastinal large B-cell lymphoma;indolent NHLs n. 37 (48%), distributed as follicular lymphoma (FL) n. 28, marginal zone lymphoma (MZL) n. 3, hairy cell leukemia (HCL) n. 3, lymphoplasmacytic lymphoma n. 1, CLL/SLL n. 3. N. 6 (7.8%) were treated inside of a clinical trial. N. 52 (67.5%) of patients received infusion chemotherapy or immune-chemotherapy and n. 25 (32.5%) received immunotherapy. According to the line of treatment, n. 38 (49.3%) received induction therapy, n. 6 (7.8%) second line therapy, n. 13 (16.9%) were at the third or higher line, and n. 20 (26%) were receiving maintenance therapy.The mean age was 56.6 (range 22-85). Authors found that 36% of patients had anxiety (HADS-A), 31% depression (HADS-D), and 43% were above the cut-off for the HADS-General Scale;36% fulfilled the diagnostic criteria for post-traumatic stress disorder (PTSD). Women and younger patients were found to be more vulnerable to anxiety and PTSD. In the subsequent months, Authors planned a more structured psychological support, based on a screening offered to outpatients with lymphoma. Summary/Conclusion: The study firstly analyzes the psychological impact of the COVID-19 pandemic on the frail population of patients affected by lymphoproliferative neoplasms, to underly the importance of screening patients for emotional and distress conditions and then offering them psychological support.