Background The aims of this study were to explore the impact of COVID-19 on health-care services and quality of life (QoL) in women diagnosed with breast cancer (BC) in Ireland and whether the impact varied by social determinants of health (SDH). Methods Women diagnosed with BC completed a questionnaire measuring the impact of COVID-19, disruption to BC services, QoL, SDH, and clinical covariates during COVID-19 restrictions. The association between COVID-19 impact and disruption to BC services and QoL was assessed using multivariable regression with adjustment for SDH and clinical covariates. An interaction between COVID-19 impact and health insurance status was assessed within the regression models. Results A total of 30.5% (n = 109) of women reported high COVID-19 impact, and these women experienced more disruption in BC services (odds ratio = 4.95, 95% confidence interval = 2.28 to 10.7, P < .001) and lower QoL (β = −12.01, SE = 3.37, P < .001) compared with women who reported low COVID-19 impact. Health insurance status moderated the effect of COVID-19 on disruption to BC services and QoL. Women who reported high COVID-19 impact experienced more disruption to BC services and lower QoL compared with women with low COVID-19 impact; however, the magnitude of these unfavorable effects differed by insurance status (Pinteraction < .05). Conclusions There was a large disruption to BC services and decrease in QoL for women with BC in Ireland during the pandemic. However, the impact was not the same for all women. It is important that women with BC are reintegrated into proper care and QoL is addressed through multidisciplinary support services.
COVID-19 has heightened social inequalities, particularly for those with non-communicable diseases (NCDs), such as cancer, and health services for NCDs have been significantly disrupted. Breast cancer (BC) is the most common cancer for women in Ireland, and the impact of the pandemic on BC care needs to be established. The purpose of this study is to explore the health care experience of women with BC during the pandemic and to investigate whether these experiences vary based on social determinants of health (SDH). The study included semi-structured qualitative interviews with 37 women who had previously participated in a related quantitative study. Individuals were selected through stratified purposive sampling to ensure data was available on information-rich cases based on SDH. Interviews were conducted in early 2021 and thematic analysis was conducted using NVivo software. Three major themes, with additional subthemes, emerged from analysis: breast cancer services; breast cancer support and communication; and mental well-being. There were differences in women’s experiences within the themes that were dependent upon the SDH, including socio-economic status (SES), region, and time since diagnosis. For example, most women experienced disrupted BC services throughout the pandemic, but disruptions were more severe for women of lower SES. Table 1 provides quotation examples as evidence for these different experiences. The pandemic has impacted women with BC considerably, but the impact differed by social inequalities and time of diagnosis. This study highlights areas for improvement in the context of BC care in Ireland and the findings will inform further policy and practice. Table 1. General experiences and variation of experience based on SDH for women receiving BC services during COVID-19 Diagnostic/screening services Active treatment services Post-treatment services General experiences “I felt a lump… so I went to my own GP. She saw me and she faxed a letter straight into [cancer centre]. Within a week, I was in [cancer centre] having seen the doctors and then followed on with biopsies and mammograms.” “Well, it was a stressful period of time because I felt it was growing. And I couldn''t do anything about it. And the hospitals weren''t really taking patients… But eventually I got called again into the… clinic. I had my operation there.” “…the safety net of going in and being told this is all normal, you’re okay. And yeah, that’s gone, even though I know I can pick up the phone if I want to. But it’s not the same.” Experience based on SDH “What happened was… I got an appointment sent out for October. And I phoned them and they said to me look, there’s probably other women that met the criteria, that needed the mammogram before me.” (low SES) “I’d wait for three months or such time until COVID was over… before he would do anything. And I, at that time, I just said “no, I can’t wait that long, that’s too long.” (low SES) “I haven''t had an MRI in about a year and I meant to be getting them every six months. So then when I did, [the lump] just showed up.” (low SES) Citation Format: Charlotte L. Myers, Catherine Waldron, Kathleen Bennett, Caitriona Cahir. COVID-19 and breast cancer care in Ireland: A qualitative study to explore the perspective of breast cancer patients on their health and health care [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5276.
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, health services for breast cancer (BC) have been disrupted. Our scoping review examines the impact of the COVID-19 pandemic on BC services, health outcomes, and well-being for women. Additionally, this review identifies social inequalities specific to BC during the pandemic. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines, the literature search was conducted using scientific databases starting from March 2020 through November 2021. Studies were identified and selected by two researchers based on inclusion criteria, and the relevant data were extracted and charted to summarize the findings. Ninety-three articles were included in this review. Main themes included are as follows: (i) the impact of COVID-19 on BC services; (ii) the impact of COVID-19 on health outcomes and well-being in women with BC; and (iii) any variation in the impact of COVID-19 on BC by social determinants of health. There were apparent disruptions to BC services across the cancer continuum, especially screening services. Clinical repercussions were a result of such disruptions, and women with BC experienced worsened quality of life and psychosocial well-being. Finally, there were social inequalities dependent on social determinants of health such as age, race, insurance status, and region. Due to the disruption of BC services during the COVID-19 pandemic, women were impacted on their health and overall well-being. The variation in impact demonstrates how health inequities have been exacerbated during the pandemic. This comprehensive review will inform timely health-care changes to minimize long-term impacts of the pandemic and improve evidence-based multidisciplinary needs.
Background The aim of this study is to explore the general impact of COVID-19 on the access and use of BC services and support and overall well-being in women living with a diagnosis of breast cancer (BC) and to investigate how these experiences varied by the social determinants of health (SDH). Methods Semi-structured qualitative interviews were conducted with women selected through stratified purposive sampling to ensure data were available on information-rich cases. Interviews were conducted in early 2021 during government restrictions due to COVID-19. Thematic analysis was conducted to obtain overall experience and variation of experience based on SDH. Results Thirty seven women participated in interviews. Three major themes, with additional subthemes, emerged from analysis: 1. breast cancer services (screening, active treatment, and routine care); 2. breast cancer support and communication (continuity of care, role of liaison, and support services); and 3. quality of life (QoL) and well-being (emotional well-being; social well-being; and functional well-being). Women’s experiences within the themes varied by socio-economic status (SES) and region of residence (urban/rural) specifically for BC services and support. Conclusion The pandemic impacted women living with and beyond BC, but the impact has not been the same for all women. This study highlights areas for improvement in the context of BC care in Ireland and the findings will inform further policy and practice, including standardized BC services, improved communication, and enhancement of cancer support services.
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