Background
A growing body of research is exploring the impact of COVID-19 on cancer care and management [
1‐
3]. Already acknowledged as being infectious and deadly [
4,
5], as of 8 January 22
nd, 2021, there are approximately 96.2 million confirmed COVID-19 cases, among which, 2.06 million deaths have already occurred [
6]. Through a retrospective analysis of 355 patients dying from the coronavirus, one in five of these patients had active cancer [
7]. Individuals with cancer can experience underlying malignancy, treatment-induced immunosuppression, and possible comorbidity [
8‐
10], and it has been shown that they are more likely to develop severe symptoms from COVID-19 [
8,
9,
11]. Research also indicates that, compared to COVID-19 patients without cancer, COVID-19 patients with cancer are more likely to have higher risks in all severe outcomes (e.g., higher mortality rates) [
8,
9]. Additional factors may further increase cancer patients' vulnerability to COVID-19, such as limited access to medical resources and cancer care, during this pandemic [
12‐
14].
Due to medical resource rationing, many cancer care and treatment services were either canceled or indefinitely postponed during the early part of the COVID-19 pandemic [
15,
16]. No longer having access to the healthcare services they were accustomed to or depended upon [
11,
16], informal cancer caregivers may now be shouldering considerably more caregiver burden due to COVID-19. While the effects of this deprivation of access to cancer care on cancer patients are well discussed [
17,
18], caregiving responsibilities influencing cancer caregivers’ health and well-being is less examined. Other than healthcare professionals in a caring role as a part of their work, an informal caregiver is generally offered unpaid or ill-compensated care to a family member or a friend, due to disease-centered or aging-related reasons. Pre-COVID-19 data show that caregivers shoulder approximately 70–89% of all care needed by patients in general [
19]. Considering the interruptions COVID-19 exerts on cancer care and treatment, it is probable that cancer caregivers are shouldering even greater caregiving responsibilities for patients.
Cancer caregivers have been facing tremendous stressors during the COVID-19 pandemic. The range of issues resembles a triple crisis of (1) confronting the impact of the coronavirus outbreak, (2) shouldering pronounced care needs from the patient, and (3) coping with considerable needs for physical and psychological care from within. In other words, in addition to being forced to deal with a pandemic and patients’ pronounced cancer care needs discussed above, caregivers may also experience substantial physical and psychological health issues that require timely medical attention. Mounting evidence indicates that cancer caregivers often face considerable caregiver burden that can negatively impact their physical and psychosocial health [
20‐
22]. In a review study, findings on 21,149 caregivers show that the prevalence of depression and anxiety is 42.30% and 46.55% in these caregivers, respectively [
23]. It is important to note that blanket measures, such as lockdowns, self-isolation, and social distancing, can exert further pressure on cancer caregivers. Research suggests that social support from community members can lower anxiety and depression experienced by cancer caregivers; these supports are significantly limited due to social distancing recommendations [
24].
Technology-based interventions refer to “the use of technology to manage or support health promotion strategies aiming to produce accessible and affordable health solutions to the target audience” [
25]. Studies have shown that technologies (e.g., telehealth) may be beneficial to address issues cancer caregivers experienced during COVID-19; with some research identifying the potential improvement to health and well-being [
26‐
28]. Technology-based interventions can offer greater accessibility to care for cancer caregivers that can be (1) delivered remotely without physical contacts between interventionists and the caregivers [
29,
30], (2) received cost-effectively without the need for transportation [
27], and accessed conveniently with self-paced learning [
31,
32] of tailored content [
33,
34]. In addressing the unique challenges cancer caregivers face amidst COVID-19, no research has identified technology-based health solutions for cancer patients that can address these needs, such as care needs, general healthcare needs, information and communication needs, and social support needs (see Table
1). Thus, to bridge this gap, this systematic review identifies the literature surrounding technology-based solutions for cancer caregivers that can mitigate challenges they face amid COVID-19.
Table 1
Cancer caregivers' unique needs associated with COVID-19
Unique challenges due to COVID-19 | Need category |
Due to cancer patients' canceled or delayed access to cancer care owing to heightened healthcare needs among COVID-19 patients, patients may need to rely more on caregivers for their care needs compared to their pre-COVID-19 normal. | Cancer care needs |
As a result of negative impacts of COVID-19 and striking caregiver burden amid COVID-19, cancer caregivers may need healthcare services that can address issues associated with their physical and psychological health. | General healthcare needs |
In addition to pronounced need for information on healthcare, due to the fear and uncertainty surround COVID-19, caregivers may need more information to help themselves as well as patients to cope with the impacts associated with COVID-19. | Information and communication needs |
Protective measures against the spread of COVID-19 (e.g., lockdowns, self-isolation, and social distancing) | Social support needs |
Discussion
COVID-19 has upended cancer care as we know it [
41‐
45]. Evidence shows that pandemics of COVID-19’s scale could be particularly deadly to vulnerable populations such as cancer patients [
2,
3,
8‐
10,
46]. Furthermore, COVID-19 prevention mechanisms, such as lockdowns, self-isolation, and social distancing measures, as well as COVID-19-induced medical resources rationing, have curbed or cut cancer patients and their caregivers’ access to traditional healthcare services [
47‐
50]. Not to mention chaos and consequences associated with pandemic information overload, COVID-19 infodemics, and dysfunctional vaccine dissemination may further compound cancer patients and their caregivers’ interaction with the ever-increasingly overstretched and overstressed healthcare systems [
51‐
53]. As a result, cancer caregivers often have to step up to address patients’ healthcare needs and wants [
42,
54‐
57], which, in turn, could exert substantial mental and physical stress on informal caregivers, above and beyond COVID-19-related burdens the general public shoulders daily [
20‐
22]. Technology-based health solutions can bypass spatial distancing constraints caused by COVID-19 and have the ability to address unique challenges cancer patients, and their caregivers face amid COVID-19 [
58‐
61].
As the frontline physician among us observed, the most challenging cancer care component during COVID-19 is how to resume cancer treatment for patients [
1]. Because the pandemic has caused severe limitations to access to cancer care and availability of transportation, across the world, many patients, even in severe conditions, had to suspend their treatment plans [
1,
56,
62]. Take Chinese cancer patients, for instance. The pandemic occurred during the Chinese traditional spring festival. As a result, a large number of cancer patients traveled home with their caregivers for their extended-family reunion. However, due to the outbreak [
63], after the spring festival, most of them were under lockdown at their hometown or somewhere in between, without access to critical cancer care and treatment options. Even among patients and caregivers who managed to rush back to the hospital for their treatments, they had to be self-quarantined for 14 days and then undergo a series of tests. Technologies, such as the “Health Code”, a digital color-coded health system that allows the governments and health agencies to track cell phone location to better determine individuals’ whereabouts (i.e., whether they have recently traveled to places witnessed severe COVID-19 outbreaks) [
64], undoubtedly have helped expedite the information processing speed, and saved valuable time these patients and caregivers desperately needed.
However, while useful insights are available in the literature, there is a dearth of research that can shed light on evidence-based and practical health solutions cancer caregivers can use to address and alleviate unique challenges they face during COVID-19 or any future disease pandemics. Therefore, to bridge this gap, we aim to identify technology-based interventions designed for cancer caregivers and report the characteristics and effects of these interventions concerning the distinctive challenges cancer caregivers face amid COVID-19. Additionally, this paper will present practical insights into the diverse intervention approaches that can help deliver digital health solutions for cancer caregivers amid and beyond COVID-19. Furthermore, this study’s results can also offer valuable insights for researchers who aim to develop interventions for cancer caregivers in the context of COVID-19. In addition, it is also expected to identify areas for improvement that need to be addressed in order for health experts to more adequately help cancer caregivers weather the storm of global health crises like COVID-19 and beyond.
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