Nearly 44% of breast cancer survivors experienced treatment delays at the outset of the COVID-19 pandemic, which has claimed the lives of more than 732,000 people worldwide, according to new research conducted at the University of Illinois Cancer Center.
“COVID-19 has had a profound impact on cancer care in the United States and around the world,” said Elizabeth Lerner Papautsky, PhD, University of Illinois Cancer Center member and assistant professor in the department of biomedical & health information sciences at the University of Illinois at Chicago, who co-authored the study with Tamara Hamlish, PhD, research scientist at the UI Cancer Center. “Healthcare strategies have predominantly been focused on managing the virus, rather than the needs of breast cancer patients requiring access to crucial services.
“We sought to learn how breast cancer survivors characterize treatment delays that occurred during the early period in the pandemic.”
More than 600 adult breast cancer survivors throughout the United States responded to the survey, which was administered in early April, weeks after the first patients in the U.S. were diagnosed with the deadly virus. Multiple factors – race, age, cancer stage, location of treatment, and form of insurance, among others – were examined from the respondents, 46% of whom were within five years of their most recent cancer diagnosis. The respondents were racially diverse – 78% were White, 17% Black and 3% Asian.
Respondents reported the highest rate of delays in routine or follow-up clinic appointments (79%), surgical breast reconstruction (66%), diagnostic imaging (60%), and lab testing (50%). The lowest rate of delays were in genetic counseling and testing (11%) and oral therapies (13%). Nearly 30% of respondents reported delays in hospital or clinic-based cancer therapies, including radiation (30%), infusion therapies (32%), and surgical tumor removal (26%).
There was no significant effect for race, insurance, site of care, or cancer stage. The only variable having a significant effect was age, with younger respondents (almost 46 years old) reporting a higher incidence of delays than their older counterparts (nearly 49 years old). The factors do not, however, explain all of the disparity in delays by age.
“First, about 11% of individuals diagnosed with breast cancer in the United States are under 45 years old,” Hamlish said. “The disease is more aggressive in this population and it has a higher rate of mortality. Secondly, data from the pandemic indicates that older people have a higher risk of mortality from COVID-19, with increased risk due to exposure during hospital or clinic-based treatment, as well as additional comorbidities.
“Despite these factors, our data suggest that older breast cancer survivors experienced significantly lower rates of delays in cancer treatment, with younger survivors bearing a disproportionate burden of treatment delays.”
Significant disparities in treatment delays by age may be due, in part, to the result of interruptions in procedures or protocols specific to young women, particularly ovarian suppression, Papautsky said. Delays in injections for ovarian suppression due to clinic closures or consolidation of clinical services in a different location were reported by some participants, while others described changes in their treatment protocol, including longer times between injections or an alternative therapy (e.g., tamoxifen) that did not require a clinic visit.
The study, published in the journal Breast Cancer Research and Treatment reported that delays in care were slightly higher among White (46%) and Asian (50%) respondents, compared to Black respondents (36%). Those with public insurance (Medicare, Medicaid) reported slightly lower rates of delay (36%) compared with respondents with employer‐sponsored health insurance (46%) or who purchased private insurance (47%).
About 276,480 new cases of invasive breast cancer will be diagnosed in American women in 2020, and nearly 42,170 women will die from the disease, making it the second leading cause of cancer death in women, according to the American Cancer Society. Except for skin cancers, breast cancer is the most common cancer in American women. To date, the average risk of a woman in the U.S. developing breast cancer during her lifetime is about 13% (about one in eight chance), and the risk of a woman dying from breast cancer is about one in 38 (about 2.6%).