12042 Background: The COVID-19 pandemic has impacted the well-being of people not only due to the disease but also because of stay-at-home orders, social distancing, unemployment, and different kinds of loses. Older adults have particularly suffered during the pandemic, with increased health-related concerns and anxiety leading to increased vulnerability. However, little is known about the effects of the pandemic on older adults with cancer living in developing countries. They are facing issues related to their diagnosis and treatment, as well as the effects of the pandemic on their care and on the well-being of their families. To improve care for this vulnerable population, we studied the concerns and difficulties associated with COVID-19 among older Mexican adults with cancer. Methods: We included patients age ≥65 with the 10 most common tumors in Mexico according to GLOBOCAN and within 3-24 months of cancer diagnosis at two public hospitals in Mexico City. Patients were contacted telephonically and asked to complete a survey reporting the difficulties encountered during the COVID-19 pandemic and to rate their concerns associated with cancer care management using a 0-10 Likert-type scale, with higher ratings meaning increased concerns. Focused interviews were used to describe the individual experience of selected patients and their relatives related to COVID-19 and cancer care. Results: Between April 20, 2020 and December 1, 2021, 67 patients (mean age 71.9, min 65, max 90; 35.8% female; 62.7% living with a partner) were included. The most common tumors were prostate (43%), colon (16%), and lung (12%). 46% had Stage IV disease, and 61% had a life expectancy of more than a year. Twenty-five percent of patients reported encountering at least one difficulty in obtaining cancer care due to the COVID-19 pandemic. 43% of the patients reported difficulties with accessing follow-up cancer care; 39% reported issues with obtaining medications, including chemotherapy; and 34% reported problems obtaining medical care in general, including oncology visits. Regarding concerns, 33% of the patients reported being “very worried” or “extremely worried” about the COVID-19 pandemic. The most relevant concerns were related to getting infected with COVID-19 (or having a family member who became infected) (mean rating 7.9, SD 2.9); not being able to pay for cancer treatments or medical care (mean rating 6.9, SD 3.5); and worsening of cancer due to delayed care during the pandemic (mean rating 6.6, SD 3.7). Conclusions: A significant proportion of older adults with cancer in Mexico faced difficulties obtaining cancer treatment and follow-up care during the COVID-19 pandemic. Their most relevant concerns included getting infected, financial losses, and progression of disease. Creating systems to provide continued cancer care for vulnerable populations in developing countries is essential to face the COVID-19 pandemic.
Nudge Versus Boost: Agency Dynamics Under Libertarian Paternalism
