Effect of disrupted rehabilitation services on distress and quality of life in breast cancer survivors during the COVID-19 pandemic

Background: Cancer rehabilitation often includes manual assessment and interventions to address cancer treatment related side effects. The effect of reduced access to rehabilitative care due to COVID-19 is currently unknown. Objective/Purpose: To assess distress and quality of life (QOL) for women receiving care for breast cancer related impairments during closure of rehabilitation services due to COVID-19. Methods: Preexisting patients returning to rehabilitation services after a COVID-19 associated interruption of treatment were asked to complete a survey regarding their distress, function, and QOL levels at the suspension of rehabilitation services and at the resumption of those services. Setting and Patients: Outpatient cancer rehabilitation clinic treating breast cancer survivors at an accredited cancer center. Measurements: Distress thermometer, FACT-G (Functional Assessment of Cancer Therapy General) survey, and visual analog scale questions regarding sleep, fatigue, and physical activity as part of reassessment by the clinician. Utility of telehealth was also explored. Results: Fifteen women (age range, 38-76 years) with primary complaints of shoulder stiffness, pain, and lymphedema completed surveys, and 33% received telehealth. Reported distress levels at the time of closure were significantly higher than self-reported levels at reopening (t14 = 4.69, P = .000). Increases in distress at the time of closure were correlated with reduced physical activity (r = -0.602, P = .018). Reduced levels of distress following return to rehabilitation were correlated with reduced levels of fatigue (r = 0.575, P = .025). No statistically significant relationships between distress and sleep quality were found. Limitations: Self-report via surveys, recall bias, and the multifactorial characteristics of distress limit study findings. Conclusion: Closure of rehabilitation services during COVID-19 created distress, resulting in reduced physical activity and QOL in breast cancer survivors. Cancer survivorship communities will need to assess the effect of disrupted service across cancer rehabilitation centers. Further research is needed to validate optimal interventions including telehealth best practice to manage distress and QOL in a COVID-19 context.