Care Delivery Impact of the COVID-19 Pandemic on Breast Cancer Care

Abstract

PURPOSE: COVID-19 has altered healthcare delivery. Previous work has focused on patients with cancer and COVID-19, but little has been reported on healthcare system changes among patients without COVID-19. METHODS: We performed a retrospective study of patients with breast cancer (BC) in New York City between February 1, 2020, and April 30, 2020. New patients were included as were patients scheduled to receive intravenous or injectable therapy. Patients with COVID-19 were excluded. Demographic and treatment information were obtained by chart review. Delays and/or changes in systemic therapy, surgery, radiation, and radiology related to the pandemic were tracked, along with the reasons for delay and/or change. Univariate and multivariable analysis were used to identify factors associated with delay and/or change. RESULTS: We identified 350 eligible patients, of whom 149 (42.6%) experienced a delay and/or change, and practice reduction (51.0%) was the most common reason. The patients who identified as Black or African American, Asian, or Other races were more likely to experience a delay and/or change compared with White patients (Black, 44.4%; Asian, 47.1%; Other, 55.6%; White, 31.4%; P = .001). In multivariable analysis, Medicaid compared with commercial insurance (odds ratio [OR], 3.04; 95% CI, 1.32 to 7.27) was associated with increased odds of a delay and/or change, whereas stage II or III BC compared with stage I (OR, 0.38; 95% CI, 0.15 to 0.95; and OR, 0.28; 95% CI, 0.08 to 0.092, respectively) was associated with decreased odds of a delay and/or change. CONCLUSION: Almost half of the patients with BC without COVID-19 had a delay and/or change. We found racial and socioeconomic disparities in the likelihood of a delay and/or change. Further studies are needed to determine the impact these care alterations have on BC outcomes.

Changes in systemic cancer therapy in Australia during the COVID-19 pandemic: a population-based study

“…[ 27 , 28 ] Single-centre studies from the US report that around half of patients on chemotherapy had treatment modifications in February to April 2020. [ 29 , 30 ] A systematic review found evidence of significant delays and disruptions to cancer care worldwide during the COVID-19 pandemic. [31] Apart from New Zealand data, there have been few studies of changes to systemic cancer therapy use in the Western Pacific region.…”

The impact of the COVID-19 pandemic on perceived access to health care and preferences for health care provision in individuals (being) treated for breast cancer

“…The COVID-19 pandemic has had consequences for cancer care, as a substantial part of cancer diagnoses and treatments worldwide were delayed or disrupted [ 3 , 7 , 18 , 19 ]. During the first month of the pandemic, a study assessing the impact of COVID-19 on breast cancer care in New York reported that 42.6% ( n = 149) of the patients experienced a cancer care delay and/or change [ 20 ]. In Australia, 42% ( n = 683) of cancer patients and survivors experienced disruption to their cancer care or treatment during the early months of the pandemic [ 21 ].…”

Barriers to breast cancer screening are worsened amidst COVID-19 pandemic: A review

“…Practice reductions in breast imaging created schedule alterations resulting in delays in screening and treatment, as the focus was shifted to caring for patients with COVID-19. 5 For African American and Hispanic patients who already experience delays in screening and treatment, the pandemic has increased delays. 5 Evidence has shown that these delays resulted in lower rates of cancers detected at screening and larger tumor size compared to pre-pandemic values.…”

“… 5 For African American and Hispanic patients who already experience delays in screening and treatment, the pandemic has increased delays. 5 Evidence has shown that these delays resulted in lower rates of cancers detected at screening and larger tumor size compared to pre-pandemic values.…”