The document discusses a study on the impact of the COVID-19 pandemic on cancer patients and their ability to receive treatment. Key findings include: 1) Over half of cancer patients had appointments cancelled or postponed, leading to delays in treatment and increased mental stress and anxiety. 2) Clinical trial participation was also impacted, with many trials being put on hold. 3) While doctors provided virtual consultations, concerns about receiving in-person care remain high, especially among recently diagnosed patients and those with late-stage cancer. 4) Fears for the future and anxiety levels rose during the pandemic and remain elevated as some restrictions are lifted.

1. IMPACT OF COVID-19 CRISIS ON
CANCER PATIENTS AND THEIR
ABILITY TO RECEIVE TREATMENT
Wednesday, July 15, 2020
11:00 am
Presented by Marjut Huotari,
VP – Healthcare Insights, Leger
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2. Research context and objectives
Research methodology
• Recruitment
• Research methodology
Key findings
Conclusion
Q&A
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5
OVERVIEW
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3. RESEARCH CONTEXT AND OBJECTIVES
Leger, on behalf of the Canadian Cancer Survivor Network (CCSN), and with the support of Advocacy Solutions,
conducted a study to assess the extent to which the disruption of cancer care caused by COVID-19 is impacting
cancer patients and caregivers, from an emotional and physical wellness perspective.
• Have appointments been cancelled or rescheduled?
• for treatment, surgery, etc.
• Have there been delays in diagnosis?
• are patients waiting for tests, e.g. biopsies, ultrasounds, etc. to confirm a
diagnosis?
• Have patients avoided going to the ER?
• for symptoms related to their cancer diagnosis etc.
• What is the emotional and mental impact of diagnosis and treatment
delays?
• How are patients and caregivers interacting with the doctor managing their
cancer
• virtual consults, in person visits, etc.
• Has clinical trial participation been affected or put on hold?
Key topics addressed
in the survey
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4. RESEARCH METHODOLOGY – SAMPLE SIZE
Data collection took place from May 22nd to June
10th , 2020.
 Web survey of 1,243 Canadians, including
960 Canadians diagnosed with cancer, 206
Caregivers and 77 Canadians in the pre-
diagnosis stage.
 The survey was made available in both
English and French.
REGIONAL ACHIEVEMENTS
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QUE 33%
ON 35%
AB 10%
BC 11% SK 2%
ATL 6%
MB 2%

5. RESEARCH METHODOLOGY – RECRUITMENT
SCREENING CRITERIA:
• 18 years or older and currently living in Canada
• Respondents qualified as:
 A patient, if they were diagnosed with cancer
 A caregiver, if a currently living family member / someone they
care for was diagnosed with cancer
 Pre-diagnosis, if they are in the process of trying to determine
if they have cancer, or to rule out cancer
• A maximum of 35% of patients to be in remission
RECRUITMENT:
• Most respondents were recruited via our LEO PANEL – Leger’s proprietary consumer panel
with nearly 500,000 members (largest in Canada):
 909 patients
 205 caregivers
 77 pre-diagnosis patients
• A portion of respondents were recruited with the help of CCSN via an open survey link:
 51 patients
 1 caregiver
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6. 6
Even split by gender Tend to skew older: 59 YEARS on averageRegionally representative across Canada
QUE 32%
ON 36%
AB 10%
BC 11%
SK 2% ATL 6%
MB 3%
RESPONDENT PROFILE – PATIENTS
BREAST (28%) and PROSTATE (21%) cancer
account for about half.
Other cancers among ~1 in 10 patients include
colon / rectal, melanoma, lung, and bladder.
28% 21%
Stage 1
20%
Stage 2
16%
Stage 3
10%
Stage 4 /
Metastatic
10%
Remission
35%
1 in 10 say they are unsure of their stage of cancer.
<2 YEARS
30%
2-5 YEARS
35%
6-10 YEARS
19%
>10 YEARS
16%
TIME SINCE
DIAGNOSIS
varies greatly
among patients;
a MAJORITY
(two thirds) were
diagnosed in the
PAST 5 YEARS.
48%52%
RURAL: 24%
TOWN/CITY: 51%
URBAN/METRO: 25%
Good mix of locations by population

7. 7
Good mix of all ages: 47 YEARS on averageRegionally representative across Canada
QUE 32%
ON 33%
AB 10%
BC 14%
SK 1% ATL 8%
MB 3%
RESPONDENT PROFILE – CAREGIVERS
<2 YEARS
50%
2-5 YEARS
27%
6-10 YEARS
11%
>10 YEARS
13%
TIME SINCE
DIAGNOSIS
varies but skews
towards more
recently diagnosed;
HALF were
diagnosed within
the last 2 years
40%60%
RURAL: 19%
TOWN/CITY: 56%
URBAN/METRO: 24%
Good mix of locations by population
Most common cancer types of
person being cared for
LUNG
CANCER: 19%
PROSTATE
CANCER: 13%
BREAST
CANCER: 34%
COLON / RECTAL
CANCER: 20%
RELATIONSHIP TO THE CANCER PATIENT
Spouse / partner
– 23%
Daughter (in-law)
– 19%
Mother (in-law) –
10%
Son (in-law) –
10%
Skews towards females
1 in 10 say they are unsure of their stage of cancer.

8. 8
Skews younger with 75% under 55 years
46 YEARS on average
Majority from QC, followed by ON
QUE 48%
ON 32%
AB 12%
BC 4%
SK 1% ATL 1%
MB 1%
RESPONDENT PROFILE – PRE-DIAGNOSIS
66%34%
RURAL: 14%
TOWN/CITY: 51%
URBAN/METRO: 32%
Tend to skew towards city / metroSkews towards males
As they wait for a
possible cancer
diagnosis…

9. KEY FINDINGS

10. KEY STUDY FINDINGS
RESTRICTIONS put in place to manage the COVID-19 crisis have
resulted in considerable DISRUPTION to many aspects of cancer care
in Canada
Despite consulting doctors using virtual modes of interaction, DELAYS
in APPOINTMENTS and TREATMENT have had a MAJOR IMPACT on
patients and their caregivers
The many DISRUPTIONS to cancer care have taken a MENTAL and
EMOTIONAL TOLL
CONCERNS about receiving adequate cancer care BOTH DURING and
AFTER COVID-19 fuel anxieties
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11. 54% HAVE HAD APPOINTMENTS
CANCELLED, POSTPONED OR RESCHEDULED
16% AVOIDED VISITING AN ER
15% HAVE HAD SURGERIES / PROCEDURES
CANCELLED
PATIENTS
50%
 RECENTLY DIAGNOSED – 68%
12%
12%
 RECENTLY DIAGNOSED – 22%
 RECENTLY DIAGNOSED – 22%
CAREGIVERS
66%
 RECENTLY DIAGNOSED – 85%
26%
23%
 METASTATIC STAGE – 49%
 LIVING IN RURAL
AREAS – 31%
PRE-DIAGNOSIS
74%
40%
30%
NOTE:
RECENTLY DIAGNOSED = DIAGNOSED <2 YEARS AGO
METASTATIC STAGE = STAGE 4 CANCER
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THREE-QUARTERS of PRE-DIAGNOSIS and RECENTLY DIAGNOSED patients have had their
APPOINTMENTS CANCELLED, POSTPONED or RESCHEDULED

12. 11% EXPERIENCED DELAYS IN STARTING /
CONTINUING TREATMENT
PATIENTS
8%
 RECENTLY DIAGNOSED – 17%
CAREGIVERS
23%
 RECENTLY DIAGNOSED – 29%
 LIVING IN RURAL AREAS – 32%
20% of RECENTLY DIAGNOSED patients experienced DELAYS in RECEIVING TREATMENT.
62% of RECENTLY DIAGNOSED patients in a CLINICAL TRIAL reported it was PUT ON HOLD / STOPPED
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CLINICAL TRIALS WERE
ALSO IMPACTED
 Four-in-ten (43%) patients, who were enrolled in or in process of being enrolled in a clinical trial
report the clinical trial being put on hold or stopped altogether
 Six-in-ten (62%) recently diagnosed patients report a clinical trial being put on hold or
stopped altogether
 Five-in-ten (52%) of those in adjuvant stage and four-in-ten (39%) of those in
metastatic stage of cancer report having an impact on clinical trial
NOTE:
RECENTLY DIAGNOSED = DIAGNOSED <2 YEARS AGO
METASTATIC STAGE = STAGE 4 CANCER
ADJUVANT STAGE = STAGE 1/2/3 CANCER

13. 74% of those who experienced DELAYS in APPOINTMENTS say it had a MAJOR
IMPACT on their MENTAL and EMOTIONAL health
IN SPITE OF CONSULTING DOCTORS
VIRTUALLY, DELAYS IN
APPOINTMENTS AND
TREATMENT HAVE HAD A HUGE
IMPACT
PATIENTS
68%
CAREGIVERS
89%
PRE-DIAGNOSIS
82%
 Worried / concerned
 Anxious
 Stressed
DELAYS HAVE ESPECIALLY HAD A
MAJOR IMPACT ON MENTAL
AND EMOTIONAL HEALTH WITH
MANY HIGHLIGHTING BEING:
“First I would like be to say NO ONE
should have any cancer appointments
cancelled or rescheduled. This is cancer
– it may even already have spread. Not
having my treatments is a nightmare.
All you keep doing in your head is
asking ‘has it spread, am I going to die
sooner or will I make it to my next
appointment?”
“I was worried as her appointment was
scheduled for the end of March. We
tried to reach the doctor and it was
concerning that their voicemail was
always full. It wasn't until that week
that we found out the appointment
was cancelled.”
“Having the doctors postpone and
cancel my appointments and
treatments makes me a bit worried
because I'm scared that what if it
spreads during the time being without
noticing”
“I am supposed to have testing done at
every appointment. I have been put off
for three (3) times since Covid-19
started. I'm worried that I may still
have growing cells. I was also supposed
to have a CT/MRI as well but have
heard nothing on a date, canceled or
otherwise.”
“It was really stressful because the day
appointments was fixed all plans and
everything was scheduled but when it is
postponed then you have to schedule
again and change everything.”
“I'm a mess!!! Not knowing is driving
me insane. I can't think straight, I don't
sleep, I don't eat....”
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14. COVID-19 HAS AFFECTED* MOST ASPECTS OF
EVERYONE’S LIFE, CAUSING FEARS FOR THE
FUTURE & INCREASED LEVEL OF ANXIETY
56% EXPRESS FEARS FOR THE FUTURE
PATIENTS
51%
49%
36%
CAREGIVERS
73%
68%
PRE-DIAGNOSIS
74%
77%
68%
FEARS FOR THE FUTURE are MOST PRONOUNCED for those who are RECENTLY
DIAGNOSED (68%) or PRE-DIAGNOSIS (74%) and those in the METASTATIC STAGE (74%)
 RECENTLY DIAGNOSED – 65%
 METASTATIC STAGE – 67%
 RECENTLY DIAGNOSED – 76%
 METASTATIC STAGE – 94%
55% HAVE INCREASED LEVELS OF ANXIETY 73%
 RECENTLY DIAGNOSED – 63%
 METASTATIC STAGE – 65%
43% FEAR THE CANCER WILL PROGRESS
 RECENTLY DIAGNOSED – 53%
 METASTATIC STAGE – 58%
 RECENTLY DIAGNOSED – 82%
 METASTATIC STAGE – 94%
 RECENTLY DIAGNOSED – 82%
 METASTATIC STAGE – 79%
NOTE: RECENTLY DIAGNOSED = DIAGNOSED <2 YEARS AGO
METASTATIC STAGE = STAGE 4 CANCER
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*SIGNIFICANT + SOME AFFECT

15. PATIENTS CAREGIVERS PRE-DIAGNOSIS
VIRTUAL HEALTHCARE
OFTEN REPLACED
IN-PERSON VISITS MODES OF INTERACTION
DURING THE PANDEMIC
85%
31%
76%
34%
GPs
Specialists
Virtual
(telephone, video consult,
e-mail, instant messaging,
text / SMS)
In-person
SATISFACTION
(VERY/SOMEWHAT
SATISFIED)
88%
92%
89%
95%
81%
35%
80%
31%
GPs
Specialists
SATISFACTION
(VERY/SOMEWHAT
SATISFIED)
75%
78%
81%
100%
72%
39%
72%
40%
GPs
Specialists
SATISFACTION
(VERY/SOMEWHAT
SATISFIED)
80%
78%
92%
70%
 Majority had a virtual
consult with their
doctor during the
pandemic, including
telephone, video
consult, e-mail, instant
messaging / online
chat, text / SMS.
 Among all virtual
modes of interactions,
telephone consult was
used the most
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Among those who INTERACTED with a physician DURING THE PANDEMIC, 83%
had a VIRTUAL CONSULTATION

16. Although many consulted doctors virtually, 71% remain CONCERNED about RECEIVING IN-PERSON
CARE – especially those recently diagnosed and pre-diagnosis patients
56% ARE CONCERNED ABOUT THEIR ABILITY TO RECEIVE
HOSPITAL CARE IF NEEDED
56% ARE CONCERNED ABOUT THEIR ABILITY TO BE CARED
FOR IN ER IF NEEDED
54% ARE CONCERNED BEING ABLE TO GET TESTS RELATED
TO CANCER
54% ARE CONCERNED ABOUT BEING ABLE TO SEE
DOCTOR MANAGING CANCER FOR FOLLOW-UPS
54% ARE CONCERNED ABOUT BEING ABLE TO GET HELP
FOR SIDE EFFECTS RELATED TO TREATMENT OR NEW
SYMPTOMS
51% ARE CONCERNED ABOUT BEING ABLE TO RECEIVE
CANCER TREATMENT IN TIMELY FASHION
PATIENTS CAREGIVERS PRE-DIAGNOSIS
51%
51%
49%
49%
48%
46%
MANY PATIENTS AND THEIR CAREGIVERS
EXPRESSED CONCERNS*
 RECENTLY DIAGNOSED – 57%
 METASTATIC STAGE – 58%
 RECENTLY DIAGNOSED – 58%
 RECENTLY DIAGNOSED – 59%
 RECENTLY DIAGNOSED – 61%
 RECENTLY DIAGNOSED – 57%
 RECENTLY DIAGNOSED – 54%
75%
72%
70%
73%
76%
67%
 RECENTLY DIAGNOSED – 78%
61%
60%
59%
61%
59%
N/A
*VERY + SOMEWHAT CONCERNED
NOTE: RECENTLY DIAGNOSED = DIAGNOSED <2 YEARS AGO & METASTATIC STAGE = STAGE 4 CANCER
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17. Even as restrictions lift, 50% of those surveyed, especially those in METASTATIC STAGE (73%)
say CONCERNS about receiving ADEQUATE CANCER CARE are FUELING ANXIETIES
ANXIETY LEVELS ROSE CONSIDERABLY DURING
THE HEIGHT OF THE COVID-19 PANDEMIC
 Five-in-ten (49%) patients reported being very or
somewhat anxious; the most anxious being:
 Those with metastatic cancer (72%)
 Those recently diagnosed (64%)
 Those diagnosed with lung cancer (65%)
 Almost eight-in-ten (76%) caregivers said they were
anxious.
 This number increases to nine-in-ten (91%)
among those caring for patients in metastatic
stage
 Seven-in-ten (71%) pre-diagnosis patients say they were
anxious during the height of the COVID-19 pandemic
35%
49%
44%
64%
76% 74%
65%
71%
64%
Patients Caregivers Pre-diagnosis
PRIOR to COVID-19
being declared a pandemic and
restrictions put in place
DURING the HEIGHT of
COVID-19
pandemic, when self-isolation
restrictions were in place
CURRENTLY,
as restrictions begin to
relax and ease
AS RESTRICTIONS EASE, LEVELS OF ANXIETY
REMAIN ELEVATED
 Four-in-ten (44%) patients report currently being anxious, with higher levels of anxiety among:
 Those with metastatic cancer (67%)
 Those recently diagnosed (56%)
 Among the caregiver group in particular there is very little easing of anxiety.
 Three-quarters (74%) of caregivers report currently being anxious, especially those caring for patients with metastatic cancer (91%)
 Anxiety remains high among pre-diagnosis patients with two-thirds (64%) reporting currently being anxious
NOTE: RECENTLY DIAGNOSED = DIAGNOSED <2 YEARS AGO & METASTATIC STAGE = STAGE 4 CANCER
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18. PATIENTS CAREGIVERS PRE-DIAGNOSIS
47%
47%
33%
AS THE COVID-19 RESTRICTIONS BEGIN TO
LIFT, MANY PATIENTS AND THEIR CAREGIVERS
REMAIN CONCERNED*
69%
70%
61%
66%
68%
60%
70%
70% of PRE-DIAGNOSIS patients are CONCERNED about DELAYS IN DIAGNOSING their cancer
N/A N/A
 RECENTLY DIAGNOSED – 53%
 ADJUVANT STAGE – 54%
 RECENTLY DIAGNOSED – 43%
*VERY + SOMEWHAT CONCERNED
NOTE: RECENTLY DIAGNOSED = DIAGNOSED <2 YEARS AGO
ADJUVANT STAGE = STAGE 1/2/3 CANCER
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52% ARE CONCERNED ABOUT DELAYS IN BEING
ABLE TO SCHEDULE APPOINTMENTS
52% ARE CONCERNED ABOUT DELAYS IN
RECEIVING TREATMENT IN A TIMELY FASHION
39% ARE CONCERNED ABOUT DELAYS
AVAILABILITY OF NEW CANCER TREATMENTS
70% PRE-DIAGNOSIS PATIENTS ARE CONCERNED
ABOUT DELAYS IN GETTING CANCER DIAGNOSTIC
TESTING AND PROCEDURES

19. CONCLUSIONS

20. CONCLUSIONS
Overall, 54% have had their CANCER CARE APPOINTMENTS CANCELLED, POSTPONED OR RESCHEDULED.
• THREE-QUARTERS of PRE-DIAGNOSIS and RECENTLY DIAGNOSED patients report having appointments
cancelled, postponed or rescheduled.
74% say delays in appointments and treatment have had a MAJOR IMPACT on their MENTAL and EMOTIONAL
HEALTH.
• METASTATIC and RECENTLY DIAGNOSED patients report highest levels of anxiety.
The majority of patients (83%) who consulted a doctor during the pandemic did so VIRTUALLY; however 71%
remained CONCERNED about receiving IN-PERSON CARE DURING THE PANDEMIC.
Even as restrictions lift, 50% say CONCERNS about RECEIVING ADEQUATE CANCER CARE are FUELING ANXIETIES.
• 70% of PRE-DIAGNOSIS patients are CONCERNED about DELAYS IN DIAGNOSING their cancer.
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21. CANADIAN CANCER SURVIVOR NETWORK
CONTACT INFO
1750 Courtwood Crescent, Suite 210
Ottawa, ON K2C 2B5
Telephone / Téléphone : 613-898-1871
E-mail: jmanthorne@survivornet.ca or info@survivornet.ca
Website: www.survivornet.ca
Twitter: @survivornetca
Facebook: www.facebook.com/CanadianSurvivorNet
Instagram: @survivornet_ca
Pinterest: http://pinterest.com/survivornetwork/