The Psychological Impact of COVID-19 on Adults Affected by Cancer: A Mixed-Methods Systematised Review

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Abstract Title: The Psychological Impact of COVID-19 on Adults Affected by Cancer: A Mixed-Methods Systematised Review Background: Coronavirus disease 2019 (COVID-19) has caused distress, anxiety and fear among people across the world. People affected by cancer are considered to be a particularly vulnerable population due to their disease, its treatments and the uncertainties surrounding their disease and COVID-19. Aim: To explore, critically appraise and synthesise the available literature on the psychological impacts of COVID-19 for cancer patients. Methods: A mixed-methods approach was employed to address this complex concept by exploring quantitative evidence for breadth and qualitative evidence for depth, and the PICO (population, intervention/exposure, context, outcome) strategy was employed to formulate the review question. A comprehensive search was conducted in three electronic databases: CINHAL, MEDLINE and PsycINFO. The mixed methods appraisal tool was employed to critically appraise studies selected from the search. A convergent synthesis approach was employed for the synthesis. Results: Eight studies (seven quantitative and one qualitative) were identified as meeting the inclusion criteria. Two themes emerged: increased anxiety and increased fear. The most notable critical appraisal issues were the use of unvalidated tools, non-probability sampling strategies and small sample sizes, subjecting the results to multiple biases and resulting in low-quality evidence. Conclusion: The evidence indicated that cancer patients reported increased levels of anxiety and fear during the pandemic. However, the current evidence base is weak and subject to change as further published research becomes available. More research is needed using a qualitative approach to explore the depth of the psychological impact of COVID-19 on cancer patients and to guide the needed support in such times.