One hundred thirty-seven participants completed the survey and represented a variety of demographic and clinical experiences. Most of the respondents were physicians and advanced practice providers (48.2%), social workers (29.5%), and oncology nurses/navigators (10.7%). The majority (83.2%) were US-based. Fifty-eight percent of the participants practiced in an academic/National Cancer Institute (NCI)–Designated Comprehensive Cancer Centers, 26.4% in community cancer centers, 4.5% in hospitals, 2.7% in physician-owned oncology practices, and 8.2% in other types of institutions (e.g., private practice). More than 62% of respondents reported at least 50% of their patient pool were older adults (Table 1).

Across the four open-ended items, six overall themes emerged. The themes included (1) telehealth use, (2) concerns for patient mental health, (3) patient physical and social isolation, (4) patient fear of contracting COVID-19, (5) continued disruptions to cancer care (including three sub-themes of restricted visitor policies, staffing issues, and patient access to cancer care), and (6) patients seeking guidance, particularly regarding COVID-19 vaccination. Overall themes and main findings are summarized in Table 2.

When asked about perceived major changes to cancer care provision for older adults during the pandemic, increased telehealth use was reported by participants, with both negative and positive views of telehealth. One participant stated,

“Technology infrastructure is needed to support telehealth communications in a safe, reliable, and effective way. Many patients did not have access to smartphones, desktops, laptops, or have access to high-speed internet. Clinicians/providers were faced with some technology support issues, cybersecurity challenges, and increased workload with providing care for COVID patients (depending on workplace setting) and juggling other work-related responsibilities while managing home life (children attending virtual school).”

However, one participant stated, “Surprisingly quick adaptation amongst many older adults to utilize smartphone and desktop computers for telehealth.”

Participants also reported seeing increased mental health conditions and distress among patients. One participant said, “Patients are afraid and experiencing more significant health-related depression and suicidal thoughts since the pandemic [took] hold.” Physical isolation from loved ones and caregivers, as well as fewer opportunities for social interaction, were perceived by participants to increase patient loneliness. One participant reported, “Loss of immediate social support from friends and family—increased loneliness.” Another participant stated, “The risk of social isolation being highlighted and exacerbated.”

Participants also reported increased fear of contracting COVID-19 among their older adult patients, which was perceived to impact care disruptions. A participant stated, “A reduction in access to support due to safety concerns. Fear has absolutely been part of decision-making, barriers to care, and availability of support.” Continued care disruptions due to COVID-19 were commonly reported as a perceived major change to cancer care for older adults. A participant stated, “Caregivers remain restricted [as visitors] inside our facilities. I find this to be a significant barrier to patient support and well-being, as well as increasing stress on caregivers and families.” Similarly, another participant reported, “Diagnosis and screening seem to be delayed while frailties are exacerbated because of difficulties accessing food, physical therapy, and social support/interactions.”

Respondents summarized changes in cancer care to include isolation and lower support while seeking care in the inpatient and outpatient settings. Seeing patients without family members or friends due to restrictions imposed by COVID-19 mandates affected patients and their caregivers. A participant said, “The experience has been more isolating for the patient, less family/friends available to be at bedside.” Another participant stated, “Caregivers not allowed in hospital or clinic, so caregiver support and input lacking during these times.” Likewise, a respondent stated, “Their family members are usually their primary caregivers. Having the no visitor policy really hurt the older adult population.”

Regarding five perceived barriers to clinical cancer care during COVID-19, participants reported barriers related to telehealth use, patient mental health, isolation, fear of contracting COVID-19, and disruptions to care. One participant stated, “Post-pandemic medical syndrome (my personal opinion diagnosis): providers are still adapted to screens as primary source of information and are not going into the room as much, fragmented care, less family engagement, short staffed, new staff, COVID-19 created large staffing turnover.” Participants also reported a desire for additional resources and infrastructure support for telehealth. A participant shared, “Intimidation by rapid use of technology (do not have access or understand how it works; no personal problem-solving assistance to make [it] work).” Regarding patient mental health, a provider stated, “Mental health of older patients—they are locked in, I observe increased dementia, cognitive dysfunction, and depression.” Additionally, another provider stated, “Fear limiting patient’s willingness to follow through with coming to appointments with providers or getting testing done timely” and those patients were experiencing “Isolation from family and friends.” Providers also reported unvaccinated patients as a perceived disruption to providing cancer care. A participant stated, “Reluctance/fear among some to get the vaccine.” Another participant stated, “Unvaccinated patients/safety concerns.”

Another common theme from five perceived clinical barriers included access to care. A common respondent theme included responses of “later stage at diagnosis,” “treatment delays,” “delayed care in many settings,” and “access to home care, hospice services, and DME [durable medical equipment] services.” Several respondents noted, “transportation” and “transportation is less available.” Other respondents included “food insecurities” and “food accessibility” in their top 5 perceived clinical barriers.

In response to what questions are being asked of cancer care providers by older adults, providers commonly reported questions from patients regarding COVID-19 vaccination, as well as questions surrounding guidance on how COVID-19 will impact cancer care. A participant stated they were being asked, “Will a booster be necessary? How long will immunity from the vaccines last? Will the vaccine work against the variants?” Another provider stated they were asked, “When will this be under control? Will cancer treatment make me more vulnerable to COVID? Should I receive the vaccine?” Providers also reported being asked about cancer care changes, including if telehealth care would still be continued and how patients could access basic and medical resources. One provider reported being asked, “How can older adults access more help in the home, and what is a safe way to do that during COVID?” Another participant reported patients seeking “mental health support”.

The concerns communicated by patients to their providers included seeking guidance on how to move forward with their treatment of cancer during COVID-19. A respondent was asked, “Should I delay treatment of care?” Another respondent was asked, “What happens to my treatment if I get COVID?” One provider reported a question from a patient: “Am I in more danger from my cancer or [from] COVID?”.

The final item (any thoughts related to providing cancer care for older adults during COVID-19) yielded themes related to continued care disruptions, concern for patients’ mental health, patient fear of COVID-19, as well as vaccination and guidance seeking. One participant stated, “The daily changes to adjust to precautions during the beginning and throughout most of last year made it difficult for me to recharge (hard to take paid time off with so many team members remaining home when exposed or had COVID). Masks and isolation requirements made me feel disconnected and tired.” Another participant expressed, “This has been a time of very high anxiety for our patients and staff. Frequent changes to safety [guidelines] also added to anxiety.” Another participant stated, “I've learned that older adults are very resilient and have been the most calm and patient with changes from the pandemic.” One participant also reported changes to their role as a result of COVID-19 “As a public health nurse, I became the EXPERT (terrifying) of COVID, having led thru the AIDS epidemic. I went from director and NP to all things COVID. This showed me how, as oncology professionals, we are taught to learn, process, and act on what we learn every hour of every day.” Another participant stated, “We never stopped seeing or treating patients during COVID; we did delay routine follow-up and did not have face-to-face visits with patients in a group living situation.”