In a single-institution retrospective study focused on a New York City location reported in JCO Oncology Practice, Satish et al found that more than 40% of patients with breast cancer not infected with COVID-19 had a delay or change in care delivery due to the pandemic.
Study Details
The study involved data from 350 patients without COVID-19 treated at Columbia University Irving Medical Center in New York between February 1, 2020, and April 30, 2020. New patients and patients scheduled to receive intravenous or injectable therapy were included in the analysis.
Delays in care (systemic therapy, surgery, radiation, and radiology) were defined as any postponement of scheduled care; changes in care were defined as care alterations without postponement. COVID-19–related delays/changes were those due to patient concern, physician concern, COVID-19 rule-out testing requirement, practice reduction, or use of a modified treatment because of the COVID-19 pandemic. Non–COVID-19–related changes/delays included those due to disease progression, side effects, and other reasons. Practice reductions included canceled or postponed appointments or procedures related to policy to limit nonurgent care to maintain social distancing, preserve personal protective equipment, or preserve staff availability.
Almost half of the patients with breast cancer without COVID-19 had a delay and/or change. We found racial and socioeconomic disparities in the likelihood of a delay and/or change. Further studies are needed to determine the impact these care alterations have on breast cancer outcomes.— Satish et al
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Key Findings
Among the 350 patients, 227 (64.9%) experienced a care delay/change, with 149 (42.6%) having a COVID-19–related delay/change. Among these 149 patients, 134 had a delay in care and 69 had a change in care.
The most common cause of COVID-19 care alterations was practice reductions (51.0%), with patient and physician safety concerns (36.2% and 21.5%) and modification of treatment (22.8%) being other common reasons.
COVID-19–related alterations in scheduled care occurred in systemic therapy for 27% of 350 patients, imaging in 21% of 281 patients, interventional radiology in 9% of 78 patients, radiation therapy in 19% of 67 patients, and surgery in 44% of 84 patients.
On univariate analysis, Black/African American (44.4%), Asian (47.1%), and patients identifying as other race (55.6%) were more likely to experience delay/change compared with White patients (31.4%; overall P = .001). Hispanic or Latino patients (48.0%) or patients who had missing ethnicity demographics (50.9%) were more likely to experience alterations vs non-Hispanic or non-Latino patients (35.9%; overall P = .05).
On multivariate analysis, 1-year increase in age (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.01–1.08) and Medicaid vs commercial insurance (OR = 3.04, 95% CI = 1.32–7.27) were associated with increased likelihood of a COVID-19–related alteration in care. Stage II (OR = 0.38, 95% CI = 0.15–0.95) and stage III disease (OR = 0.28, 95% CI = 0.08–0.092) were associated with reduced likelihood of care alteration vs stage I disease. No associations of race, ethnicity, or receptor status with care alteration were observed.
The investigators concluded, “Almost half of the patients with breast cancer without COVID-19 had a delay and/or change. We found racial and socioeconomic disparities in the likelihood of a delay and/or change. Further studies are needed to determine the impact these care alterations have on breast cancer outcomes.”
Melissa K. Accordino, MD, MS, of Columbia University Herbert Irving Comprehensive Cancer Center, is the corresponding author for the JCO Oncology Practice article.
Disclosure: For full disclosures of the study authors, visit cancer.columbia.edu.
