COVID-19 Pandemic: Changes in Care for a Community Academic Breast Center and Patient Perception of Those Changes

Abstract

Background Philadelphia and its suburbs were an epicenter for the initial COVID-19 outbreak. Accordingly, alterations were made in breast cancer care at a community hospital. Methods The authors developed a prospective database of all the patients with invasive or in situ breast cancer between March 1 and June 15 at their breast center. Any change in a breast cancer plan due to the pandemic was documented, and the patients were grouped into two cohorts according to whether a change was made (CTX) or no change was made (NC) in their care. The patients were asked a series of questions about their care, including those in the Generalized Anxiety Disorder two-item questionnaire (GAD-2), via telephone. Results The study enrolled 73 patients: 41 NC patients (56%) and 32 CTX patients (44%). The two cohorts did not differ in terms of age, race, or stage. Changes included delay in therapy (15.1%) and use of neoadjuvant endocrine therapy (NET, 28.8%). The median time to surgery was 24 days (interequartile range [IQR], 16–45 days) for the NC patients and 82 day s (IQR, 52–98 days) for the CTX patients ( p ≤ 0.001). The median duration of NET was 78 days. The GAD-2 showed anxiety positivity to be 29.6% for the CTX patients and 32.4% for the NC patients ( p = 1.00). More than half (55.6%) of the CTX patients believed COVID-19 affected their treatment outlook compared with 25.7% of the NC patients ( p = 0.021). Conclusions A prospective database captured changes in breast cancer care at a community academic breast center during the initial phase of the COVID-19 pandemic. 44% of patients experienced a change in breast cancer care due to COVID-19. The same level of anxiety and depression was seen in both change in therapy (CTX) and no change (NC). 55.6% of CTX cohort believed COVID-19 affected their treatment outlook.

Impact and Future Changes to Breast Cancer Care Due to Covid-19

“…Patients were also given a survey Generalized Anxiety Disorder two-item (GAD-2) questionnaire which revealed that 31.2% of patients screened positive for anxiety and depression. Interestingly this was not statistically different between women who had a change in care due to COVID-19 or rates of GAD-2 positivity for women with breast cancer outside of the COVID-19 pandemic [7][8]. From multiple studies on both the From these studies we see that there were changes implemented in the care of breast cancer patients.…”

“…The impact on cancer and non-cancer health outcomes may take years to fully understand. Another study captured changes across a health system in the northeast which was an epicenter of COVID-19 [7]. In this analysis 44% of patients experienced a change in treatment with 65.6% of patients with a change in treatment receiving NET and 34.4% experiencing a delay in surgery alone.…”

ASO Author Reflections: Changes in Breast Cancer Care and Patient Perception During the Initial Wave of COVID-19

“…We also sought to assess if these changes were associated with negative reactions from patients related to their overall mental health, breast cancer care, and outlook. 3…”

“…Lankenau Institute for Medical Research, Wynnewood, PA; 2 Lankenau Medical Center, Wynnewood, PA; 3 The Bryn Mawr Hospital, Bryn Mawr, PA…”

Pattern of Time-to-Surgery in Patients With Breast Cancer at Different Stages of the COVID-19 Pandemic

“…Although the existing studies conducted on TTS changes among patients with breast cancer during COVID-19 are mainly cross-sectional, the available evidence confirmed a time-delay in cancer treatment. High mortality risk diseases, such as cancers should not be neglected during the pandemic ( 10 – 13 ) and priorities should be determined. To date, there has been no studies that have dynamically analyzed the pattern of TTS changes at different stages of the COVID-19 pandemic.…”