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Health-related Quality of Life Among Unmarried Patients Diagnosed With Lung Cancer Worse During COVID-19 Than Before

Key findings

  • In 2018, investigators at Massachusetts General Hospital and 22 other sites launched two clinical trials of palliative care for patients recently diagnosed with advanced lung cancer, allowing a comparison of data before and during the COVID-19 pandemic
  • This cross-sectional analysis explored associations of the COVID-19 pandemic with health-related quality of life (HRQOL) and depression symptoms of 665 patients enrolled before COVID-19 relative to 191 patients enrolled during the pandemic
  • Overall, the two groups did not differ at enrollment with respect to HRQOL or depression symptoms, but unmarried patients enrolled during COVID-19 reported significantly worse HRQOL than the other group
  • These results will help clinicians identify newly diagnosed patients at risk of worse HRQOL during times of crisis and provide supportive resources

In 2018, investigators at Massachusetts General Hospital and 22 other sites began conducting two randomized clinical trials of telehealth for palliative care delivery among patients recently diagnosed with advanced lung cancer. This will provide unique opportunities to compare patient-reported outcomes before and during the COVID-19 pandemic.

In one recent exploratory analysis, Laura A. Petrillo, MD, a palliative care physician in the Division of Palliative Care and Geriatric Medicine at Mass General, Joseph A. Greer, PhD, program director of the Center for Psychiatric Oncology and Behavioral Sciences, and colleagues found no overall influence of the COVID-19 pandemic on health-related quality of life (HRQOL) or depression symptoms.

However, in the Journal of Palliative Medicine, they report that relationship status moderated the pandemic's effect on HRQOL.


For this study the researchers analyzed baseline data from the trials. They included 856 patients who had been diagnosed with advanced lung cancer in the past 12 weeks:

  • 665 enrolled before the pandemic (March 2018 to January 2019)
  • 191 enrolled during the pandemic (March 2020 to January 2021)

At the time of enrollment, patients completed the following:


Overall, whether patients enrolled before or during the COVID-19 pandemic had no bearing on HRQOL or depression symptoms.

However, relationship status interacted with HRQOL (β=5.18; P=0.039). Specifically, the association between enrollment during the pandemic and HRQOL was significant among patients who were unmarried but not those who were married or living together as though married.

Within the unmarried subgroup, the adjusted mean difference between FACT-G scores during the pandemic relative to those before the pandemic was −5.25 (P=0.011). The domain that drove the difference was functional well-being, suggesting caregiving support may have been particularly lacking in these patients.

Applying the Findings to Practice

These study findings may help clinicians determine which patients recently diagnosed with advanced cancer are experiencing additional distress during a catastrophic event and direct them to supportive care resources. Ideally, all such patients would have their HRQOL comprehensively evaluated, be screened for psychological distress, and be referred to mental health resources as indicated.

Learn about the Division of Palliative Care and Geriatric Medicine

Refer a patient to the Division of Palliative Care and Geriatric Medicine


Massachusetts General Hospital researchers report that when palliative care physicians were embedded in the ED early in COVID-19, they had a goal of care conversation with 59% of acutely ill patients they saw in collaboration with emergency physicians, and 61% of conversations included discussion of prognosis.


Joseph A. Greer, PhD, and colleagues began studying palliative care video visits two years before the COVID-19 pandemic. They say technical difficulties related to video visits improved early in the pandemic, while in-person visits became more difficult because patients' family members were more often absent.