Psychosocial impact of COVID-19 pandemic on patients with solid malignancies and bone metastases (PsyCO-B): a multicentre prospective observational study

Background: COVID-19 pandemic dramatically changed our daily habits. Patients with cancer, particularly those with bone metastases (BM), were among the most concerned individuals, due to both their clinical condition and social distancing. Objectives: This study aimed to explore psychosocial effects of the pandemic on patients with BM, investigating the role of clinical severity, psychological symptoms, coping strategies, and perceived traumatic impact. Methods: Six questionnaires were administered to patients with BM from three Institutions: Hospital Anxiety-Depression Scale, WHO Quality of Life-BREF, Attitude Toward Seeking Professional Psychological Help, Brief Illness Perception Questionnaire, Brief COPE, and Impact Event Scale-Revised (IES-R). Clinical, pathological, and socio-demographic data were collected and analyzed using descriptive statistics. Clinical severity was estimated by applying a specific prognostic model. Statistical analyses included correlations, linear regressions and mediation analyses. Results: Clinical severity was significantly associated with depressive symptoms whereas the perceived traumatic impact of the COVID-19 pandemic was strongly associated with anxiety, the use of specific coping strategies (social support, avoidance and religiosity) and greater openness to psychological support. Mediation analysis showed that the IES-R mediates the relationship between subjective perception of illness and anxiety. Conclusions: During the pandemic, depressive symptoms in patients with BM were mainly related to their specific clinical condition, whereas those associated with anxiety were mostly due to the experience of pandemic-associated trauma. The psychological impact of the pandemic influenced coping strategies and the request for support, regardless of the disease severity. These findings highlight the importance of psycho-oncological support focused on the patient's experience and clinical condition.