COVID-19-Related Fear and Health-Related Safety Behavior in Oncological Patients
Open accessAbstract
Objective: This study aimed to assess cancer patients’ psychological burden during the COVID-19 pandemic by investigating distress (distress-thermometer), health status (EQ-5D-3L), general anxiety (GAD-7), COVID-19-related fear and associated behavioral changes and comparing these to matched healthy controls, using propensity score matching (PSM). Methods: During the first days of the COVID-19 pandemic in Germany, March 16 to 30, 2020, 150 actually treated cancer patients and 150 matched healthy controls participated in this study. Participants completed an anonymous online survey assessing health status, distress, general anxiety, COVID-19-related fear and behavioral changes (i.e. adherent safety behavior and dysfunctional safety behavior). Results: Cancer patients showed no elevated level of distress, U = 10657.5, p = .428, general anxiety U = 10015.5, p = .099, or COVID-19-related fear compared to healthy controls, U = 10948, p = .680. Both groups showed elevated COVID-19-related fear. Cancer patients reported more adherent safety behavior, such as washing hands more often or avoiding public places, U = 8285, p < .001, d = 0.468. They also reported more dysfunctional safety behavior such as buying larger quantities of basic food, compared to healthy controls U = 9599, p = .029, d = 0.256. Adherent safety behavior could be significantly explained by cancer diagnosis, increased COVID-19-related fear and subjective level of information about COVID-19, R² = .215 (F(3) = 27.026, p < .001. Conclusions: This suggests that cancer patients are more likely to utilize adherent safety behavior. Cancer patients reported comparable levels of distress and anxiety compared to healthy controls. Still, the COVID-19 pandemic is associated with elevated COVID-19-related fear. Therefore, specific interventions are needed to prevent anxiety and improve mental health during the COVID-19 pandemic.
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In a study comparing 150 cancer patients and 150 healthy individuals, no significant difference was found between the groups regarding fear of COVID-19, anxiety and stress levels.
“In a study comparing 150 cancer patients and 150 healthy individuals, no significant difference was found between the groups regarding the fear of COVID-19, anxiety and stress levels.”
From Psychological Distress of Breast Cancer Survivors During the COVID-19 Pandemic and Related Factors: A Controlled Study. (2023) · cites this paper as [15]
Cancer patients performed more COVID-19-related safety behaviors, such as hand washing and avoiding public environments, than the healthy group.
“cancer patients performed more COVID-19-related safety behaviors, such as hand washing and avoiding public environments, than the healthy group.[15]”
From Psychological Distress of Breast Cancer Survivors During the COVID-19 Pandemic and Related Factors: A Controlled Study. (2023) · cites this paper as [15]
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Carrasco, A. J. P., Bezmenov, A., Sibelius, U., & Berthold, D. (2022) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091221140075 · Cited by 7 · see citing works
Implementation and evaluation of the school's COVID-19 prevention website
Chang, J.-H., Wang, C., Zhong, H.-X., Chen, P.-W., Pan, A.-J., & Chiu, P. (2022) · Library Hi Tech · doi:10.1108/lht-10-2021-0348 · Cited by 6 · see citing works
Effects of self-management education on COVID-19 prevention in patients undergoing hemodialysis
Cho, Y. H., Cho, J., & Cho, O. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e12931 · Cited by 6 · see citing works
Frank, T., Pichler, T., Maier, S., Batenhorst, I., Abawi, T., Harbeck, N., Algül, H., Heinemann, V., Hermelink, K., Mumm, F., et al. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1100236 · Cited by 6 · see citing works
Trenta, A. M., Belloni, S., Ausili, D., Caruso, R., Arrigoni, C., Russo, S., Moro, M., Vellone, E., & Dellafiore, F. (2021) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvab097 · Cited by 6 · see citing works
Fear of Covid-19 and perceived academic safety: the buffering role of personal resources
Azila-Gbettor, E. M., Mensah, C., & Agbodza, M. (2023) · International Journal of Educational Management · doi:10.1108/ijem-04-2022-0159 · Cited by 6 · see citing works
Rupa, R., Saß, B., Lema, M. A. M., Nimsky, C., & Voellger, B. (2020) · Healthcare · doi:10.3390/healthcare8040483 · Cited by 6 · see citing works
Predictors of Poor Precautionary Practices Towards COVID-19 Among Cancer Patients
Jazieh, A. R., Bensalem, A., Bounedjar, A., Benbrahim, Z., Alorabi, M., Abusanad, A. M., Tashkandi, E. M., Al-Nassar, M., Kinge, A. R. A. D. E., Al‐Sukhun, S., et al. (2021) · Future Oncology · doi:10.2217/fon-2021-0193 · Cited by 5 · see citing works
Recio-Vivas, A. M., Domínguez, J. M. M., Eraso, Á. G. B., Peña-Otero, D., Díaz-Pérez, D., Lorenzo‐Allegue, L., & Font‐Jiménez, I. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192315983 · Cited by 5 · see citing works
Brasseler, M., Fink, M., Mitschdörfer, B., Reimann, M., Skoda, E., Bäuerle, A., Teufel, M., Felderhoff‐Müser, U., & Hüning, B. M. (2023) · Children · doi:10.3390/children10050787 · Cited by 5 · see citing works
Self-citationDecision Conflicts in Clinical Care during COVID-19: A Patient Perspective
Haier, J., Beller, J., Adorjan, K., Bleich, S., de Greck, M., Griesinger, F., Hein, A., Hurlemann, R., Mees, S. T., Philipsen, A., et al. (2022) · Healthcare · doi:10.3390/healthcare10061019 · Cited by 5 · see citing works
Patient-reported experiences of cancer care related to the COVID-19 pandemic in Switzerland
Colomer‐Lahiguera, S., Canella, C., Giacomini, S., Van, K. L., Pedrazzani, C., Naegele, M., Thouvenin, L., Stern, A. O., Condorelli, R., Corbière, T., et al. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-07871-8 · Cited by 5 · see citing works
Cho, O., Cho, Y.-H., & Chung, M.-Y. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph181910348 · Cited by 5 · see citing works
Benecke, A.-V., Schmidt, K., Dinse, H., Schweda, A., Jahre, L. M., Fink, M., Weismüller, B., Dörrie, N., Welsner, M., Skoda, E., et al. (2022) · Healthcare · doi:10.3390/healthcare10050858 · Cited by 4 · see citing works
Self-citationMao, Y., Ma, W., Kang, D., Miao, Y., Fu, H., Zhang, B., Zhang, J., & Wu, J. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1122894 · Cited by 4 · see citing works
The Burden of the Pain: Adverse Mental Health Outcomes of COVID-19 in Women With and Without Cancer
Lanzoni, L., Brivio, E., Oliveri, S., Guiddi, P., Chichua, M., Mazzocco, K., & Pravettoni, G. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.772128 · Cited by 4 · see citing works
Postvaccine Era COVID-19 Pandemic-Related Distress in Palliative Care Patients With Advanced Cancer
Shih, K. K., Arechiga, A. B., Chen, X., Urbauer, D. L., de Moraes, A. R., Rodriguez, A. J., Thomas, L., Stanton, P. A., Bruera, E. D., & Hui, D. (2023) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2023.06.028 · Cited by 4 · see citing works
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Ibach, M. J., Winter, A., Seika, P., Ritschl, P. V., Berndt, N., Dobrindt, E. M., Raakow, J., Pratschke, J., Denecke, C., & Maurer, M. M. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13061560 · Cited by 3 · see citing works
Die Auswirkungen der COVID-19-Pandemie aus der Sicht ambulanter Krebspatienten
Pichler, T., Frank, T., Maier, S., Batenhorst, I., Abawi-Daltrozzo, T., Harbeck, N., Algül, H., Heinemann, V., Hermelink, K., Mumm, F., et al. (2022) · DMW - Deutsche Medizinische Wochenschrift · doi:10.1055/a-1746-7534 · Cited by 3 · see citing works
Wegener, G., Hummers, E., Müller, F., Schröder, D., Roder, S., Dopfer‐Jablonka, A., Behrens, G. M. N., Steffens, S., & Schmachtenberg, T. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e20344 · Cited by 3 · see citing works
Jafari, H. S., Heidari, M., Sheikhi, R. A., ZEBARDAST, F., MOHAMMADI, M., & Nemati, S. (2022) · Minerva Psychiatry · doi:10.23736/s2724-6612.22.02344-2 · Cited by 2 · see citing works
Searl, J. P., Genoa, K., Fritz, A. M., Kearney, A., Pandian, V., Brenner, M. J., & Doyle, P. C. (2023) · American Journal of Otolaryngology · doi:10.1016/j.amjoto.2023.104126 · Cited by 2 · see citing works
Mensah, N. K., Adzakpah, G., Abakah, J., Opoku, C., Wadere, M., Dogbe, M., Senyah, D., Agyarkoaa, M., Mensah, L., & Appiah‐Acheampong, A. (2025) · Health Science Reports · doi:10.1002/hsr2.70898 · Cited by 2 · see citing works
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Khalkhali, M., Zarvandi, P., Mohammadpour, M., Alavi, S. M. K., Khalkhali, P., & Farrahi, H. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05742-y · Cited by 2 · see citing works
Fear of COVID-19 and its influence on palliative care patients
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Oncological patients' reactions to COVID ‐19 pandemic: A single institution prospective study
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Sağaltıcı, E., Sönmez, Ö., Karcı, E., Şahin, Ş. K., & Ertürk, A. (2021) · International Journal of Research in Counseling and Education · doi:10.24036/00435za0002 · Cited by 2 · see citing works
The Relationship Between COVID-19 Anxiety and Preoperative Anxiety During the Pandemic
Çetinkaya, F., & Aslan, K. S. Ü. (2022) · Journal of PeriAnesthesia Nursing · doi:10.1016/j.jopan.2022.10.004 · Cited by 1 · see citing works
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Burns, M. F., Krueger, E., Hanna, N. H., Durm, G. A., Ceppa, D. P., Jalal, S. I., Birdas, T. J., Kesler, K. A., Einhorn, L. H., & Mosher, C. E. (2025) · Journal of Health Psychology · doi:10.1177/13591053241312672 · Cited by 1 · see citing works
On the dynamics of a COVID-19 model with vaccination and social processes
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Anxiety trajectories among cancer survivors during the COVID-19 pandemic
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anuk, D. (2023) · Turkish Journal of Oncology · doi:10.5505/tjo.2023.3934
“[15] In addition, the decisions of some states to delay nonemer-gency health services in health systems to reduce the risk of infection make it difficult for cancer survivors to continue their routine check-ups, or although there is no disruption in the health system, it is known that they postpone…”
BackgroundDie Auswirkungen der COVID-19-Pandemie aus der Sicht ambulanter Krebspatienten
Pichler, T., Frank, T., Maier, S., Batenhorst, I., Daltrozzo, T., Harbeck, N., Algül, H., Heinemann, V., Hermelink, K., Mumm, F., et al. (2022) · TumorDiagnostik & Therapie · doi:10.1055/a-1874-4718
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Criscuolo, M. G., Perna, S., Hermann, A., Stefano, C. D., & Marfè, G. (2023) · Research Square · doi:10.21203/rs.3.rs-3263600/v1
RetractedSchmachtenberg, T., Wegener, G., Königs, G., Müller, F., Müllenmeister, C., & Schröder, D. (2023) · Archives of Microbiology & Immunology · doi:10.26502/ami.936500131
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Pietsch, S., Geiger, E., Babst, R., Wünsch, A., & Bauer, P. R. (2025) · Springer eBooks · doi:10.1007/978-3-658-48682-2_3
COVID-19パンデミック状況下の一般集団およびがん患者の精神的健康
駿地, 眞. (n.d.) · Institutional Repositories DataBase (IRDB)
Development and validation of the Essen Melanoma Quality of Life Inventory (EMQoLI)
Musche, V., Schadendorf, T., Schweda, A., Lodde, G. C., Neumann, J., Zimmer, L., Hüning, S., Schadendorf, D., Skoda, E.-M., Livingstone, E., et al. (2026) · JDDG Journal der Deutschen Dermatologischen Gesellschaft · doi:10.1111/ddg.15998
Self-citationIqbal, J., Naveed, M. A., & Asghar, M. Z. (2026) · Health & Social Care in the Community · doi:10.1155/hsc/5978658
- Authors
- Musche, V., Bäuerle, A., Steinbach, J., Schweda, A., Hetkamp, M., Weismüller, B., Kohler, H., Beckmann, M., Herrmann, K., Tewes, M., Schadendorf, D., Skoda, E.-M., & Teufel, M.
- Affiliations
- Essen University Hospital (DE)
- Corresponding author
- Musche, Venja
- ORCID
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2020-08-05
- Volume
- 11
- Pages
- 1984-1984
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC7438892
- OpenAlex
- W3047487680
- Cited by
- 99
- References
- 48
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 6 · 2023: 20 · 2022: 27 · 2021: 35 · 2020: 2
- FWCI
- 8.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Universität Duisburg-Essen
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- COVID-19 pandemic, cancer patients, fear of COVID-19, safety behavior, psychological distress, anxiety, health behavior, mental health, COVID-19 information
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