During a worldwide pandemic that has caused the deaths of more than 1.3 million people – including more than 250,000 Americans – COVID-19 is just one more thing to worry about for adult breast cancer survivors, according to new research conducted at the University of Illinois Cancer Center and published in the journal Cancer Investigation.
“The emotional distress associated with a breast cancer diagnosis and treatment has been well-documented, but the health risks associated with the COVID-19 pandemic, such as delays and interruptions in care and the risk of infection from the virus, have increased the vulnerability of breast cancer survivors and the risk of emotional distress,” said Elizabeth Lerner Papautsky, PhD, assistant professor in the Department of Biomedical & Health Information Sciences at the University of Illinois Chicago and a member of the University of Illinois Cancer Center’s Cancer Prevention and Control program.
“Our findings suggest that the COVID-19 pandemic may result in more worry for vulnerable breast cancer survivors than their less at-risk counterparts.”
The study, completed by 633 American breast cancer survivors, examined the extent of health-related worry (cancer, COVID-19, and general health) – as a function of breast cancer survivors’ vulnerability, such as treatment status, immunocompromised status, and experience of COVID-19-related treatment delays. Papautsky and Tamara Hamlish, PhD, research scientist at the UI Cancer Center who served as the study’s co-author, also examined the relationship between patients and their health care team to learn whether trust, good communication, and planning could help reduce the worry patient’s experience.
“We learned that respondents who are in active treatment, immunocompromised, and experiencing delays in care are more worried about their cancer, as consistent with our study hypotheses,” Hamlish said. “Additionally, immunocompromised respondents also reported greater worry about their general health and getting COVID-19. It is reasonable to expect vulnerable individuals to be more worried in situations that pose additional risk to their health and delays to their care.”
Effective communication between patients and their health care team has the potential to alleviate emotional stress, Papautsky said. The question, she said, is how to do so.
“There are so many barriers in play,” Papautsky said. “Time constraints, and the workload of health care providers. This is amplified in a pandemic because of the uncertainty they face – financial resources, space to treat the patients, including operating rooms. They don’t know when things will get back to normal.”
Respondents to the survey were 78% white and 17% Black, with the average age being nearly 48. About 62% reported currently undergoing active treatment, and about one-third of the participants said they were immunocompromised. Forty-four percent of the respondents experienced COVID-19-related delays in their cancer treatment and care.
Breast cancer is the second most common cancer among women in the United States (some kinds of skin cancer are the most common). Black women and white women get breast cancer at about the same rate, but Black women die from breast cancer at a higher rate, according to the Centers for Disease Control and Prevention (CDC).
In 2019, about 268,600 new cases of invasive breast cancer and 48,100 cases of ductal carcinoma in situ (DCIS) were diagnosed among U.S. women, and 41,760 women were expected to die from the disease, said the American Cancer Society (ACS). Eighty‐two percent of breast cancers are diagnosed among women aged 50 years or older, and 90% of breast cancer deaths occur in this age group. The median age at diagnosis for female breast cancer is 62 years; it is slightly younger for Black women (60 years) than for white women (63 years). The median age at breast cancer death is 68 years overall – 70 years for white women, and 63 years for Black women.
The new paper is the second published by Papautsky and Hamlish based on data they collected at the outset of the pandemic focused on care delays and interruptions in breast cancer due to the worldwide health crisis.
“Often we are focused on clinical outcomes, but we should also be paying attention to other types of outcomes such as mental health,” Papautsky said. “It is something people live with on a daily basis as a function of cancer care and the uncertainty of the pandemic.”