Mental health and adherence to covid-19 protective behaviors among cancer patients during the covid-19 pandemic: An international, multinational cross-sectional study

Angelos P. Kassianos, Alexandros Georgiou, Maria Kyprianidou, Demetris Lamnisos, Jeļena Ļubenko, Giovambattista Presti, Valeria Squatrito, Marios Constantinou, Christiana Nicolaou, Savvas Papacostas, Gökçen Aydin, Yuen Yu Chong, Wai Tong Chien, Ho Yu Cheng, Francisco J. Ruiz, Maria B. Garcia-Martin, Diana Obando, Miguel A. Segura-Vargas, Vasilis S. Vasiliou, Louise McHughStefan Höfer, Adriana Baban, David Dias Neto, Ana Nunes da Silva, Jean Louis Monestès, Javier Alvarez-Galvez, Marisa Paez Blarrina, Francisco Montesinos, Sonsoles Valdivia Salas, Dorottya Őri, Bartosz Kleszcz, Raimo Lappalainen, Iva Ivanović, David Gosar, Frederick Dionne, Rhonda M. Merwin, Andreas Chatzittofis, Evangelia Konstantinou, Sofia Economidou, Andrew T. Gloster, Maria Karekla (Coresponding Author), Anastasia Constantinidou (Coresponding Author)

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
2 Downloads (Pure)


A population-based cross-sectional study was conducted during the first COVID-19 wave, to examine the impact of COVID-19 on mental health using an anonymous online survey, enrolling 9565 individuals in 78 countries. The current sub-study examined the impact of the pandemic and the associated lockdown measures on the mental health, and protective behaviors of cancer patients in comparison to non-cancer participants. Furthermore, 264 participants from 30 different countries reported being cancer patients. The median age was 51.5 years, 79.9% were female, and 28% had breast cancer. Cancer participants reported higher self-efficacy to follow recommended national guidelines regarding COVID-19 protective behaviors compared to non-cancer participants (p < 0.01). They were less stressed (p < 0.01), more psychologically flexible (p < 0.01), and had higher levels of positive affect compared to non-cancer participants. Amongst cancer participants, the majority (80.3%) reported COVID-19, not their cancer, as their priority during the first wave of the pandemic and females reported higher levels of stress compared to males. In conclusion, cancer participants appeared to have handled the unpredictable nature of the first wave of the pandemic efficiently, with a positive attitude towards an unknown and otherwise frightening situation. Larger, cancer population specific and longitudinal studies are warranted to ensure adequate medical and psychological care for cancer patients.

Original languageEnglish
Article number6294
Issue number24
Publication statusPublished - 1 Dec 2021


  • Cancer patients
  • COVID-19
  • Health behaviors
  • Mental health
  • Protection behaviors

Field of Science*

  • 3.2 Clinical medicine
  • 1.6 Biological sciences

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database


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