The Impact of Canadian Medical Delays and Preventive Measures on Breast Cancer Experience: A Silent Battle Masked by the COVID-19 Pandemic

Fortin, Justine; Rivest‐Beauregard, Marjolaine; Defer, Clarisse; Leblanc, Mélissandre; Louis, Lunie Anne Thamar; Roy, Carol-Anne; Lapierre, Isabelle; Brunet, Alain; Montreuil, Michèle; Marin, Marie‐France

doi:10.1177/08445621221097520

Cited by 6 publications

(7 citation statements)

References 47 publications

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“…The same finding was true for approximately 75% of prediagnosis and recently diagnosed patients [35]. In another Canadian study, patients reported feeling dehumanized while receiving their medical care for breast cancer [33]. Taken together, a higher proportion of patients presenting with metastatic disease in our analysis would be consistent with this interruption in care, the pandemic having coincided with our retrospective timeframe (2021 to 2023).…”

Section: Discussionsupporting

confidence: 78%

“…(2) the entry criteria of the study were skewed for higher-risk, more progressive patients; and (3) the COVID-19 pandemic influenced timely access to care. The impact of the COVID-19 pandemic on the spectrum of cancer care, including delaying diagnoses and treatment, is well documented [30][31][32][33]. For example, provincial breast cancer screening programs were suspended for several months during the pandemic [32].…”

Section: Discussionmentioning

confidence: 99%

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A Real-World Retrospective Analysis of the Management of Advanced Urothelial Carcinoma in Canada

Moria,

Park,

Eigl

et al. 2024

Current Oncology

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Locally advanced or metastatic urothelial carcinoma (aUC) presents a significant challenge with high mortality rates. Platinum-based chemotherapy remains the established frontline standard of care, and a switch-maintenance strategy with immunotherapy has now emerged as a new standard for aUC patients without disease progression, following initial platinum therapy. Examining the treatment patterns is imperative, given the evolving therapeutic landscape. In this study, we conducted a retrospective medical chart review of 17 Canadian oncologists treating patients with aUC to assess unmet needs in Canadian aUC patient care. Data from 146 patient charts were analyzed, revealing important clinical insights about the management of aUC. A substantial proportion of patients (53%) presented with de novo metastatic disease, which was possibly influenced by pandemic-related care disruptions. Variability was evident in the cisplatin eligibility criteria, with a majority (70%) of oncologists utilizing a 50 mL/min threshold. Most favored four cycles of platinum-based chemotherapy to spare the bone marrow for future therapies and prevent patient fatigue. Notably, some eligible patients were kept under surveillance rather than receiving maintenance therapy, suggesting a potential gap in awareness regarding evidence-based recommendations. Furthermore, managing treatment-related adverse events was found to be one of the biggest challenges in relation to maintenance immunotherapy. In conclusion, our findings provide the first comprehensive overview of aUC treatment patterns in Canada following the approval of maintenance immunotherapy, offering insights into the decision-making process and underscoring the importance of evidence-based guidelines in aUC patient management.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

A Real-World Retrospective Analysis of the Management of Advanced Urothelial Carcinoma in Canada

Moria,

Park,

Eigl

et al. 2024

Current Oncology

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“…Our study adds to the growing body of work that has demonstrated how COVID-19-related treatment delays among breast cancer patients lead to increased anxiety and depression [18][19][24][25][26][27]. For example, one Korean study of 154 breast cancer patients found that COVID-19-related treatment changes signi cantly correlated with depression [19].…”

Section: Discussionmentioning

confidence: 71%

Impact of the COVID-19 pandemic on psychosocial outcomes among women experiencing breast health delays in New York City

Fasano

Bayard

et al. 2023

Preprint

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Purpose: Reallocation of healthcare resources during the beginning of the COVID-19 pandemic resulted in delays for breast cancer care. Data are sparse regarding the impact of these delays on psychosocial outcomes. Methods: This cross-sectional study utilized validated instruments to measure psychosocial outcomes of women with and without breast cancer experiencing healthcare delays. Results: The study population was comprised of 30 (35%) recently diagnosed breast cancer patients, 24 (28%) women without cancer, and 31 (36%) breast cancer survivors (n = 85). Overall, 58% reported a delay in breast health care. Compared to those who did not report any delays, women with delays had higher levels of anxiety, (78% vs. 58%; p = 0.059), perceived stress (45% vs. 28%; p = 0.17), loneliness (67% vs. 32%; p = 0.003), and depression (16% vs. 8.3%; p = 0.34); and no or low emotional support (58% vs. 28%; p = 0.008). Conclusion: Women with and without breast cancer experiencing a healthcare delay reported more symptoms of anxiety, depression, perceived stress, and loneliness, and less emotional support. Longer time to treatment was experienced by breast cancer patients with higher levels of psychosocial morbidity. When future healthcare resource constraints lead to substantial treatment delays, providers should consider the psychosocial impacts of these delays and consider systematic screening to identify patients in need of additional support.

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“…This observation sheds light on the potential impact of COVID-19 on both patient- and facility-related management delays. Furthermore, these two factors could help explain the differences in patient presentations before and after the COVID-19 pandemic, as reported in the literature [ 20 , 21 ]. However, it is worth noting that other variables, such as age and comorbidity, did not show a statistically significant association in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Hawrot's study documented a median duration of 23 days from presentation to histological diagnosis [ 20 ]. Additionally, Fortin's study demonstrated that the timing of BC diagnosis and treatment nearly doubled during the pandemic compared to pre-pandemic times [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer Management Timelines in a Tertiary Care Center During the COVID-19 Pandemic, Makkah City, Saudi Arabia: A Retrospective Study

Alhassani¹,

Alqurashi²,

Alhassani³

et al. 2023

Cureus

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Background: Breast cancer (BC) is a prevalent form of cancer and a leading cause of death among women worldwide. In Saudi Arabia, it accounted for 31.8% among females of all new cancer cases reported in 2018. Following the declaration of COVID-19 as a global pandemic, there was a complete redistribution of healthcare resources to face this crisis, which caused a significant delay in the management of various diseases, including BC. There is currently a lack of research in our region on the facility time interval in BC management. Therefore, this study aimed to fill this gap by determining the timelines of diagnosis, management, and factors influencing the delay. Methods: This observational retrospective study included all female patients diagnosed with BC at or referred to King Abdullah Medical City (KAMC) in Makkah, Saudi Arabia, between January 2020 and August 2021. The data for this study were obtained from a centralized electronic chart review of all included patients at the KAMC center. Results: A total of 76 patients were included in the study, with a mean age of 50 ± 11 years. In terms of the disease management duration, 20 patients (26.3%) completed their management within 30 days, 28 patients (36.8%) had a management duration between 31 and 60 days, and the management duration of 28 patients (36.8%) exceeded 60 days. Patient deposition showed a significant association with delay (p = 0.033). A higher incidence of delays at the initiation of treatment was observed in patients who failed to attend appointments (p < 0.001). Among patients who skipped two or more appointments, 12 individuals (80%) experienced a delay of more than 60 days. Moreover, appointment cancellation was associated with delayed treatment initiation (p = 0.03). Patients' age and comorbidity showed no significant association (p = 0.49, p = 0.24, respectively). Conclusion: Our findings highlight the significant impact of patient deposition and canceled or skipped appointments on delayed initiation of therapy for BC patients. Further research should be conducted to evaluate the impact of COVID-19 on other malignancies.

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The Impact of Canadian Medical Delays and Preventive Measures on Breast Cancer Experience: A Silent Battle Masked by the COVID-19 Pandemic

Cited by 6 publications

References 47 publications

A Real-World Retrospective Analysis of the Management of Advanced Urothelial Carcinoma in Canada

A Real-World Retrospective Analysis of the Management of Advanced Urothelial Carcinoma in Canada

Impact of the COVID-19 pandemic on psychosocial outcomes among women experiencing breast health delays in New York City

Breast Cancer Management Timelines in a Tertiary Care Center During the COVID-19 Pandemic, Makkah City, Saudi Arabia: A Retrospective Study

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