US Patients With Breast Cancer Report Care Delays Amid COVID-19

Sharon Worcester

August 24, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Nearly half of all US breast cancer survivors who responded to a recent Internet-based survey reported experiencing delays in cancer care in the early weeks of the COVID-19 pandemic.

Of 609 respondents, 44% reported delays across all aspects of care and treatment, underscoring the "pervasive impact of COVID-19 on cancer care," the researchers note.

The findings were published online August 9 in Breast Cancer Research and Treatment.

The authors argue that their findings highlight critical gaps in disaster preparedness that leave vulnerable cancer survivors at increased risk for poor cancer outcomes.

The findings are of particular concern, given the fact that, on the basis of a National Cancer Institute model, tens of thousands of excess cancer deaths are predicted to occur over the next decade as a result of COVID-19-related delays in diagnosis and care.

"Overall, we see that there is a serious gap in disaster preparedness when it comes to providing critical and often time-sensitive care for breast cancer patients," first author Elizabeth Lerner Papautsky, PhD, research assistant professor of biomedical and health information sciences at the University of Illinois at Chicago College of Applied Health Sciences, commented in a statement.

The survey found that neither race, insurance, site of care, nor cancer stage was significantly associated with treatment delays.

The incidence of delays was higher among younger patients: the mean age of those who reported care delays was 45.94 years, vs 48.98 among those who did not report delays. This could possibly be related to the withholding of hormone therapy for ovarian suppression, which is given for certain types of breast cancer, most often in younger patients, Papautsky commented in the statement.

The survey participants were racially diverse adults (average age, 47.8 years) who were recruited via snowball sampling. Survey invitations were distributed between April 2 and April 7, 2020, to breast cancer patient support networks through social media and email.

Delays were most common for routine or follow-up clinic appointments, surgical breast reconstruction, diagnostic imaging, and lab testing. They were least common for genetic counseling and testing and for oral therapies.

"The data suggest that despite documented disparities in breast cancer outcomes and access to care based on factors such as race, insurance, site of care, and geography, the pandemic response resulted in widespread barriers to breast cancer care regardless of other pre-existing healthcare system inequities," wrte Papautsky and coauthor Tamara Hamlish, PhD, a research scientist in the cancer survivorship program at the University of Illinois Cancer Center.

The study was limited by a lack of survey validation and potential selection bias. Nevertheless, the findings underscore a need for attention to the differential impact of care delays in addressing the care backlog, the authors write.

That differential impact is "evidenced in part in the documented disparities in both breast cancer and COVID-19 mortality," they note.

"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," they add.

Papautsky and Hamlish have disclosed no relevant financial relationships.

Breast Cancer Res Treat. Published online August 9, 2020. Abstract

Sharon Worcester is a reporter for MDedge News, part of the Medscape Professional Network.

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