Half of breast cancer survivors experienced substantial psychological distress during COVID-19

Half of breast cancer survivors in Hong Kong who recently received the diagnosis experienced a moderate-to-severe level of psychological distress during the COVID-19 pandemic, a cross-sectional study has shown.

“After completion of active treatment, breast cancer survivors require a range of supportive cancer care services for rehabilitation. [However,] some oncology services were postponed in Hong Kong to prioritize resources for managing COVID-19,” wrote the researchers.

A total of 209 female breast cancer survivors who received the diagnosis as early as January 2020 (ie, the start of the COVID-19 pandemic in Hong Kong) were recruited from the Hong Kong Breast Cancer Registry to complete a cross-sectional survey on unmet supportive care needs in physical, psychological, sexuality, health system or information, and patient care or support domains.  [Hong Kong Med J 2025;doi:10.12809/hkmj2311302]

“Since our patients were recently diagnosed breast cancer survivors [average time since diagnosis, 16.6 months], they were still in the process of coping with their diagnosis, side effects of treatment, uncertainties about the future, and the possibility of cancer recurrence,” noted the researchers.

During the COVID-19 pandemic, 20.1 and 49.3 percent of the breast cancer survivors experienced disruptions in cancer treatment and supportive cancer care service, respectively.

“Half [50.2 percent] of breast cancer survivors in Hong Kong experienced a moderate-to-severe level of psychological distress during the COVID-19 pandemic,” noted the researchers.

Multivariable logistic regression analyses indicated that unmet physical or daily living needs (odds ratio [OR], 1.03; 95 percent confidence interval [CI], 1.01–1.06; p=0.002) and unmet psychological needs (OR, 1.06; 95 percent CI, 1.03–1.09; p<0.001) were significantly associated with moderate-to-severe psychological distress.

“Research suggests that telehealth can empower [cancer] survivors and provide strategies for coping during unprecedented times,” recommended the researchers. “To address the physical and psychological needs of breast cancer survivors, healthcare providers should consider how telemedicine services can provide remote support for symptom management and psychological counselling.”

Of note, perceived severity of COVID-19–related health consequences (OR, 1.67; 95 percent CI, 1.08–2.57; p=0.02), but not fear of COVID-19 (OR, 1.04; 95 percent CI, 0.56–1.96; p=0.89), was associated with moderate-to-severe psychological distress among local breast cancer survivors.

“Cancer and its treatments [eg, chemotherapy] may weaken patients’ immune system, and it is common for breast cancer survivors to believe that being immunocompromised might lead to more severe health consequences if they are infected with COVID-19,” pointed out the researchers. “Health information about COVID-19 may not always be tailored for cancer survivors or effectively communicated through local mass media, which could be associated with psychological distress among local breast cancer survivors.”

“Provision of up-to-date educational materials can help alleviate distress and risk perceptions related to COVID-19,” added the researchers. “We recommend that health organizations tailor health information and provide counselling for cancer survivors through alternative platforms, such as social media and online forums.”

Disruptions of cancer treatment, unmet patient care and supportive needs, unmet health system and information needs, and unmet sexuality needs (all p>0.05) were not significant contributors to moderate-to-severe psychological distress.