COVID-19, breast cancer care, and social determinants of health: a cross-sectional study to investigate the impact of a pandemic on health care and quality of life

Abstract

Purpose The aim of this study is to understand the impact of COVID-19 on breast cancer (BC) services and quality of life (QoL) in women living with and beyond BC in Ireland and whether the impact varied by social determinants of health (SDH). Methods The survey study invited women diagnosed with BC in the past five years to complete a questionnaire measuring the impact of COVID-19, disruption to BC services, QoL, SDH, and clinical covariates during a period of COVID-19 restrictions. The association between COVID-19 impact, disruption to BC services, and QoL was assessed using logistic and linear regression respectively with adjustment for SDH and clinical covariates. Interactions between COVID-19 impact and SDH were explored. Results 30.5% of women reported a high COVID-19 impact, which was associated with younger age, urban living, and employment status. Over half of all women reported disrupted BC services. A high COVID-19 impact was associated with more disruption to BC services and lower QoL scores. Women in post-active treatment and further removed from their diagnosis reported significantly more disruption to BC services. Younger women and women not employed reported significantly lower QoL scores. Additionally, there were significant interactions between health insurance status and COVID-19 impact on both outcomes. Conclusion The COVID-19 pandemic has significantly impacted women with a prior diagnosis of BC in Ireland, and this impact varied by SDH, including age, region, employment status, and health insurance status. Further research is needed to understand the long-term impact of the pandemic on women with BC.