The emotional impact of COVID-19 on Australian cancer patients, their caregivers, and oncology health professionals over time: A longitudinal qualitative study

Background: Cross-sectional research has highlighted the emotional impacts of coronavirus disease 2019 (COVID-19) in cancer communities. The aim of this study was to extend findings and to provide a longitudinal perspective of emotional effects of COVID-19 on a range of participants, including patients with cancer, their family members, and oncology health professionals (HPs) in Australia. Methods: This mixed-methods, longitudinal study incorporated semistructured interviews and psychological well-being survey data collected at three time points between June 2020 and October 2021. Results: Seventy-seven participants volunteered at time point 1 (T1; 32 patients, 16 caregivers, 29 HPs), 52 at timepoint 2 (23 patients, 10 caregivers, 19 HPs), and 43 at timepoint 3 (19 patients, 8 caregivers, 16 HPs). Overall, participants were psychologically well; however, elevated depressive symptoms were detected in HPs by timepoint 3. Qualitative results highlighted the emotional toll of COVID-19 for all participant groups over time. Three shared themes emerged: (1) balancing fear and safety, (2) uncertainty in an ever-changing situation, and (3) fatigue due to lack of support and sense of isolation. An additional theme unique to HPs was also identified: (4) a sense of dread for what is to come in an already exhausted workforce. Conclusion: Despite Australia's relatively low COVID-19 case numbers, an emotional toll on the cancer community was apparent. Longitudinal results indicate consistency of themes over time with the burden for HPs adding a theme by the third interview. Participants were challenged to balance needs of personal safety against cancer priorities in an environment of uncertainty and isolation. Over time, a sense of fatigue emerged, and for HPs, increased workloads left many feeling overwhelmed and unsupported with a sense of dread around future outcomes.