Breast cancer survivorship care during the COVID-19 pandemic within an urban New York Hospital System

Abstract

To examine clinicodemographic determinants associated with breast cancer survivorship follow-up during COVID-19. Methods: We performed a retrospective, population-based cohort study including early stage (Stage I-II) breast cancer patients who underwent resection between 2006 and 2018 in a New York City hospital system. The primary outcome was oncologic follow-up prior to and during the COVID-19 pandemic. Secondary analyses compared differences in follow-up by COVID-19 case rates stratified by ZIP code. Results: A total of 2942 patients with early-stage breast cancer were available for analysis. 1588 (54%) of patients had attended follow-up in the year prior to the COVID-19 period but failed to continue to followup during the pandemic, either in-person or via telemedicine. 1242 (42%) patients attended a follow-up appointment during the COVID-19 pandemic. Compared with patients who did not present for follow-up during COVID-19, patients who continued their oncologic follow-up during the pandemic were younger (p ¼ 0.049) more likely to have received adjuvant radiation therapy (p ¼ 0.025), and have lower household income (p ¼ 0.031) on multivariate modeling. When patients who live in Bronx, New York, were stratified by ZIP code, there was a modest negative association (r ¼ À0.56) between COVID-19 cases and proportion of patients who continued to follow-up during the COVID-19 period. Conclusion:We observed a dramatic disruption in routine breast cancer follow-up during the COVID-19 pandemic. Providers and health systems should emphasize reintegrating patients who missed appointments during COVID-19 back into regular surveillance programs to avoid significant morbidity and mortality from missed breast cancer recurrences.

Breast Cancer Management in the Era of Covid-19; Key Issues, Contemporary Strategies, and Future Implications

“… Breast cancer patients receiving NET can be managed safely by adopting the same way as patients with similar tumours treated with a surgery-first approach. Mo et al, USA 106 Retrospective, population-based cohort study 1 Mar 2019–1 Dec 2020 2942 (NR) Follow-up after resection of stage I/II breast cancer during COVID-19 situations Only 42% of patients attended follow-up during the pandemic. Patients being younger, with lower socio-economic status, and previously taking adjuvant radiotherapy were more likely to participate in the follow-up.…”

“…They suggested that breast cancer survival rates decline if follow-up care is not fully re-established. 106 …”

COVID-19, breast cancer care, and social determinants of health: a cross-sectional study to investigate the impact of a pandemic on health care and quality of life

“…Globally, there has been a large disruption to BC services during the pandemic [32], and the current study coincides with this trend. Previous research found that follow-up BC visits decreased by about half from 2019 to 2020 [10].…”

“…To reduce the risk of COVID-19 for BC patients, diagnostic and surgical procedures were delayed, treatment plans changed, and routine follow-up visits postponed [6][7][8]. Across a number of countries, studies have shown that many BC patients experienced a change in their recommended treatment during the pandemic [9,10].…”

“…Studies on health inequalities pertaining to COVID-19 and BC are limited, and have mainly been conducted in the USA, and include SDH such as insurance status, race, and income [5,10,21,22]. Speci cally in Ireland, there is a lack in knowledge of the impact of COVID-19 on women with BC and related health inequalities, but previous research in Ireland have associated health inequalities with the large disparity between private health insurance and public health insurance; individuals with private health insurance typically access services quicker than those without private insurance [23].…”