Iran Journal of Nursing

Introduction
The outbreak of COVID-19 caused fear and anxiety in people, mostly in the elderly, which affected their health. Old age is associated with life-threatening diseases such as cancer, which can double the stress and psychological complications. Therefore, health interventions and evidence-based support needed the assessment and monitoring of COVID-19-related psychological disorders. Therefore, this study aimed to determine the fear of COVID-19 in the elderly newly diagnosed with cancer referred to hospitals affiliated to the Alborz University of Medical Sciences in Iran.

Methods
This is a longitudinal study. The study population consists of all elderly people with cancer referred to the selected hospitals affiliated to the Alborz University of Medical Sciences (Shahid Rajaei, Imam Ali, and Kosar). Of these, 174 inpatients/outpatients were selected using a continuous sampling method and based on the inclusion criteria, which were age ≥60 years, having any type of cancer newly diagnosed by a physician, no cognitive impairment (a score of 7 in the Abbreviated Mental Test), no mental illness and no psychedelic medication use according to family caregivers or medical records, and the ability to communicate.  Data was collected using a demographic form, the Abbreviated Mental Test, and the 7-item fear of COVID-19 scale. Due to the COVID-19 pandemic, the questionnaires were completed by an interview through phone in three periods: at the time of cancer diagnosis and treatment, one month after, and two months after. Completion of the questionnaires took 3-4 months, from July to November 2021. After collecting the data, they were analyzed using SPSS software, version 22.

Results 
The mean age of the elderly was 66.85±5.86 years; 54.1% were female and 45.9% were male. Most of them had lower than high school education (67.5%), were married (77.7%), housewkeeper (42.9%), retired (40.1%), were living with their spouses (52.2%), and had insufficient income (71.3%). Breast cancer (32.5%) and colon cancer (19.7%) were the most common types of cancer among the elderly. Fear of COVID-19 level at the time of cancer diagnosis was moderate (mean score: 17.69±4.74). In the second stage (one month after the diagnosis), the mean score was 14.26±4.09. In the third stage (two months after diagnosis), the mean score was 11.81±4.13. The results of repeated measures analysis of variance showed that fear of COVID-19 two months after diagnosis was significantly lower than that one month after (P<0.001) and at the time of diagnosis (P<0.001). The mean fear score one month after diagnosis was significantly lower than at the time of diagnosis (P<0.001). Fear of COVID-19 at the time of cancer diagnosis was significantly differennt based on marital status (P=0.049), underlying diseases (P=0.014) and perception of health (P=0.004). It was higher in divorced or widowed elderly and in the elderly with an underlying disease. The elderly with higher perception of health, had lower fear of COVID-19.

Conclusion 
Any stress and anxiety, such as fear of COVID-19, can potentially disrupt the treatment and chemotherapy sessions in the elderly with cancer. In this study, fear of COVID-19 in the elderly newly diagnosed with cancer was at the moderate level at the time of cancer diagnosis, but one and two months after the diagnosis, there was a decline in their fear. Fear of COVID-19 was significantly different based on marital status, history of underlying disease, and perception of health. Policy makers Iran should pay attention to the fear of pandemics to help improve the mental health of elderly people’ with cancer. It is recommended that, in addition to conducting further research, counseling sessions should be provided to promote the mental health of the elderly with cancer, mainly at the time of diagnosis, during the pandemics. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Iran University of Medical Sciences (Code. IR.IUMS.REC.1400.125). Verbal consent was obtained from the participants, and their information was kept confidential.

Funding
The paper was extracted from the master’s thesis of the first author in geriatric nursing, funded by Iran University of Medical Sciences.

Authors' contributions
Conceptualization and Supervision: Farideh. Bastani; Methodology: Farideh. Bastani, Saeede Esmaeili; Investigation: Saeede Esmaeili; Writing–review & editing: Farideh Bastani; Data collection: Saeede Esmaeili; Data analysis: Saeede Esmaeili, Hamid Haghani, Farideh Bastani; Funding acquisition and Resources: Farideh. Bastani.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to express their gratitude to the Vice-Chancellor for Research of Iran University of Medical Sciences and all the seniors participated in this study for their support and cooperation.

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