Breast Cancer and COVID-19: The Effect of Fear on Patients' Decision-making Process

Abstract

Background/Aim: Coronavirus-19 (COVID-19) pandemic outbreak is currently having a huge impact on medical resource allocation. Breast Cancer (BC) patients are concerned both with BC treatment and COVID-19. This study aimed to estimate the impact of anxiety among patients, caused by the spreading of COVID-19. Patients and Methods: Between the 16th of January and the 20th of March 2020, we retrospectively enrolled 160 patients. Eighty-two patients with a suspected breast lesion (SBL) were divided into two groups: PRE-COVID-19-SBL and POST-COVID-19-SBL. Seventy-eight BC patients were divided into PRE-COVID-19-BC and POST-COVID-19-BC. Patient characteristics including age, marital status, SBL/BC diameter, personal and family history of BC, clinical stage and molecular subtype were recorded. Procedure Refusal (PR) and Surgical Refusal (SR) were also recorded with their reason. Results: BC and SBL analysis showed no difference in pre-treatment characteristics (p>0.05). Both POST-COVID-19-SBL and POST-COVID-19-BC groups showed higher rates of PR and SR (p=0.0208, p=0.0065 respectively). Infection risk represented primary reason for refusal among POST-COVID-19 patients. Conclusion: COVID-19-related anxiety could affect patients' decisionmaking process. Since December 2019, the novel coronavirus (SARS-COV-2) has emerged as a highly contagious human pathogen. On March 20, 2020 more than 234000 cases were confirmed worldwide , with more than 9800 registered deaths (1). Following the initial outbreak in the Chinese Hubei Province on March 11, WHO has labelled the latest coronavirus disease COVID-19 (caused by SARS-COV-2) as a pandemic. The reported fatality rate is 4.2% globally (1, 2). Human to human transmission occurs through direct contact or air droplets (2) placing health care providers at a high risk due to the close proximity to potentially infected patients (3). Preliminary data of nationwide analysis in China demonstrated cancer as a risk factor for developing severe complications/disease course among COVID-19 patients (4, 5). Although further studies are required in order to accurately estimate the risk (6, 7) among patients who underwent chemotherapy or surgery in the months prior to the outbreak, the risk of developing severe conditions seems considerably higher compared to the general population (6). Breast Cancer (BC) is the most common neoplasm worldwide representing the primary cause of death due to neoplasms in Italy (5). A report published in 2017 stated that more than 50% of BC patients were older than 60 years (8). Therefore, due to the higher risk of adverse events in older patients, underlined in the preliminary data (9), it is essential to evaluate the risk of COVID-19 infection among these frail BC patients (10). Furthermore, during the COVID-19 outbreak, hospital resources are reallocated from elective and semi-elective procedures to meet the needs of COVID-19 patients in critical conditions (11). The subsequent scarcity of resources could potentially delay diagnostic evaluations and treatment of BC ...

Perspectives, Knowledge, and Fears of Cancer Patients About COVID-19

“…The main strength of our study is the evaluation of both infecting with COVID-19 and having an impaired cancer care fear together with the sources of patient knowledge and the accuracy of the general knowledge about COVID-19 in a multidimensional manner. The study was conducted in a rather large patient sample and included patients with a wide range of ages and patients with a variety of tumors rather than a specific age or tumor group (11,23).…”

The Effect of Coronavirus (COVID-19) on Breast Cancer Teamwork: A Multicentric Survey

“…Today, having no reliable data regarding the end of the epidemic, the idea of postponing all treatments until the end of the outbreak is not feasible for cancer patients. Therefore, several guidelines have been published in order reduce the detrimental effect of COVID-19 outbreak (2,7,8,(31)(32)(33). Triage of urgent clinical cases, awake and fast track surgery could increase the number of treated patients, reducing hospitalizations as well as the risk of cross-infection during the COVID-19 era (8,(34)(35)(36)(37)(38).…”

“…Triage of urgent clinical cases, awake and fast track surgery could increase the number of treated patients, reducing hospitalizations as well as the risk of cross-infection during the COVID-19 era (8,(34)(35)(36)(37)(38). Breast oncological treatment was only partially impaired by the COVID-19 outbreak and breast specialists try to provide the best cancer treatment for a higher number of patients (2,7,8,35,39). Hence, breast cancer specialists could provide a good model for understanding how the COVID-19 outbreak could influence health well-being among the low risk HCWs population.…”

“…increasing numbers of health care workers (HCWs) have been facing a new highly contagious infectious disease (5). In spite of having a separate route and applying infection control (IC) measures during this period, patients could refuse surgery or diagnostic procedures due to COVID-19 infection risk, reducing the number of admitted patients in the hospital (2,(6)(7)(8). Moreover, IC measures include instructions to HCWs to maintain a physical distance from other colleagues, patients and families which could eventually lead to psychological distress (9)(10)(11).…”

The Impact of the COVID-19 Pandemic on Breast Imaging

“…Over 81% of survey participants acknowledged practicing social distancing 49 . In an Italian study, during the height of the outbreak, there was a significant increase in patients refusing to undergo diagnostic appointments and breast biopsies at a major cancer center 50 .…”