Cancer Care Disruption and Health-Related Quality of Life Among a Tri-Ethnic Sample of Women Diagnosed with Breast Cancer during the COVID-19 Pandemic

Background and Purpose: The COVID-19 pandemic has disrupted cancer care delivery and contributed to altered treatment protocols and delayed access to services with the potential to affect patients’ health-related quality of life (QoL) and long-term survival. Interruptions to oncology services negatively impact the emotional well-being of breast cancer patients, contribute to greater emotional vulnerability, and poorer cognitive functioning. Breast cancer patients from minoritized racial and ethnic groups already experience worse outcomes, which may have been exacerbated by co-occurring social determinants of health and treatment delays. This study investigated differential rates of cancer care disruption and affected health-related QoL among non-Hispanic Black, Latina, and Non-Hispanic White women diagnosed with breast cancer during the pandemic. Additionally, differences by psychosocial, interpersonal, and experiences navigating health care services were investigated.

Methods: Cancer survivors were recruited through community-based organizations, advocacy groups, and community bulletin boards. Study recruitment efforts were also conducted in target clinic sites serving women with breast cancer from minoritized groups. Survey data collected from 41 cancer survivors were analyzed. Cancer care disruptions were measured with a series of questions investigating the impact of the COVID-19 outbreak on access to health care services. Health-related QoL was assessed with the Functional Assessment of Cancer Therapy-Breast (FACT-B). Group mean difference analysis (ANCOVA) controlling for covariates (age, education, employment, marital status, and treatment) explored variations between groups on continuous variables, whereas chi-square tests compared participants on sociodemographic and medical factors. In addition, the association between patient outcomes and proximal, intermediate, and distal factors was examined with bivariate correlations. Significance was set at p<0.05 and analyses were performed using SAS 9.4.

Results: Participants were mostly non-Hispanic Black survivors (41.5%) and were diagnosed with early-stage breast cancer in their mid-40s (mean 45.02; SD=11.58). All participants endorsed cancer care disruptions due to the pandemic, with no significant differences between groups. The most reported impact of COVID-19 on health care services was transition to telemedicine (56.1%), followed by treatment being delayed by >2 weeks (39.02%). Care disruptions affected surgical procedures (46.3%), outpatient treatments (39.0%) and supportive services (39.0%). Disruptions were attributable to healthcare facilities’ protocols (60.9%), anxiety about potential exposure (36.6%), and provider’s recommendation to reduce cancer-related risks (34.15%). Patients who were younger (r=-0.32, p=0.042) and those diagnosed early in the pandemic (r=0.39, p=0.013) cited greater disruptions. Health-related QoL was positively associated with satisfaction with care (r=0.31, p=0.04) and negatively associated with social isolation (r=-0.49, p=0.001).

Conclusions and Implications: The present work further extends current understanding of the effects of the pandemic on cancer care disruptions among breast cancer survivors. Additionally, this study has identified groups of survivors at risk of adverse outcomes. Younger survivors, women diagnosed during the early stages of the pandemic, and those with limited social interactions presented greater vulnerability. Results emphasize pandemic-related psychological, healthcare system and health equity challenges that should be addressed to deliver patient-centered breast cancer care in a post-acute COVID-19 environment. These findings substantiate the need to enhance social workers’ preparation in addressing barriers to care and overall well-being for breast cancer survivors.