Age a Leading Factor in COVID-19–Related Breast Cancer Treatment Delays

Results from a questionnaire distributed within the first weeks of the coronavirus disease 2019 (COVID-19) pandemic show that 44% of breast cancer survivors experienced treatment delays for their disease, according to the study published in Breast Cancer Research and Treatment.

These disruptions happened more often for younger vs older women (HR, 0.97; 95% CI, 0.95-0.99; P < .001) and were typically related to ovarian suppression hormone therapies; they included injection delays from clinic closure, treatment protocol changes, and alternative therapies for which clinic visits were deemed unnecessary.

"The motivation for the study came from widespread reports of cancer care being delayed or procedures being canceled in the beginning of the pandemic, and we wanted to get a better handle on what was happening," said Elizabeth Papautsky, PhD, MS, assistant professor of biomedical and health information sciences at the University of Illinois Chicago College of Applied Health Sciences, in a statement.

Together with her coauthor, Tamara Hamlish, PhD, a research scientist in the cancer survivorship program at the University of Illinois Cancer Center, the pair developed a 50-item questionnaire on care delays they distributed via social media and email to breast cancer survivor groups in the United States. During the April 2-27 study period, 609 responses were received.

Among the 44% of respondents who reported care delays, most (79%) were from delayed follow-up appointments, with the others being breast reconstruction surgery (66%), diagnostic imaging (60%), and lab testing (50%). Thirty percent of respondents also reported hospital- and clinic-based treatment delays comprising radiation (30%), infusion therapies (32%), and surgical tumor removal (26%). The mean (SD) age at diagnosis was 43 (10.84) years.

A majority (63%) of the respondents were receiving care for their breast cancer at the time of the survey, with the mean age of the younger vs older women being 45.94 (10.31) years and 48.98 (11.10) years, respectively. Respondents identified as White (78%), Black (17%), and Asian (3%). There was 1 male respondent.

Snowball sampling was used to accrue responses; binary logistic regression accounted for the influence of race, cancer stage, care site, health insurance coverage, and age; and descriptive statistics considered delay type.

The coauthors pointed out that many of the pandemic’s emerging care guidelines focus on needs of the patients sickened with COVID-19, because they have been immediately affected by the disease, and that “interruptions in care due to disasters often result in increased rates of disease progression, pain, and excess mortality.”

Additional results show the following:

• More respondents with Medicare or Medicaid coverage (36%) experienced lower rates of delay compared with respondents who had employer-sponsored health insurance (46%).
• A plurality (45%) were receiving their care at academic medical centers.
• More White (46%) than Black (36%) respondents experienced delays.
• Genetic counseling and testing (11%) and oral therapies (13%) had the lowest rates of delay.

The authors hope their results are used in the aftermath of the pandemic to aid in how health care services are distributed and utilized, as well as to support future potential disaster planning for care disruptions, pointing to what they termed “ad hoc or reactive work-arounds” as the principal method of reallocating resources during this time.

“As strategies emerge to address the backlog of patients whose care has been delayed, it is critical to recognize the differential impact of delays across the healthcare system, evidenced in part in the documented disparities in both breast cancer and COVID-19 mortality,” Papautsky and Hamlish concluded. “The factors underlying these disparities must be recognized and addressed in the development of systems and processes to deliver high quality cancer care to those whose care has been delayed to reduce the risk of exacerbating existing health inequities and ensure access to high quality cancer care for all breast cancer survivors.”

Study limitations the authors mention, which could affect generalizability of their results, are that the results were not validated and the social media distribution of the survey may have influenced the response rate by younger survivors.

Reference

Papautsky EL, Hamlish T. Patient‑reported treatment delays in breast cancer care during the COVID‑19 pandemic. Breast Cancer Res Treat. Published online August 9, 2020. doi:10.1007/s10549-020-05828-7