The 1-year local COVID-19 restrictions negatively impacted breast cancer stage at presentation, time to treatment, and time to surgery at an urban safety-net hospital, increasing the vulnerability of an already high-risk population. These findings were from a recent study presented by Kapp et al at the American Society of Breast Surgeons 23rd Annual Meeting, which compared breast cancer care before and after COVID restrictions.

“We hypothesized that the pandemic would cause delays across all parameters studied, and our research corroborates this,” said lead study author Kelly Kapp, MD, PGY-4 General Surgery Resident at University of Missouri–Kansas City School of Medicine. “Given that our population already had a history of presenting with threefold higher rates of late-stage cancer prepandemic, the increased risk and the implications for care and outcomes are enormous.”

Study Methodology

In the study, 82 patients diagnosed with breast cancer from March 2020 to April 2021 were identified through the University of Missouri–Kansas City School of Medicine’s breast cancer registry. They were compared with 90 similar patients included in the same database from March 2018 to February 2019. Data were collected on all parameters being studied as well as on patient demographics. Late-stage cancer was defined as stage III or IV.

Disparities Discovered

Patients were more likely to present with late-stage disease in the COVID cohort than pre-COVID (31.7% vs 18.9% P = .05). After controlling for race and type of insurance coverage, women were 1.2 times more likely to present with late-stage disease during COVID restrictions than prior to COVID. Mean time to first treatment was 48 days compared to 29 days pre-COVID. Mean time to surgery, when it was the first treatment, was 65 days during COVID and 36 days pre-COVID.

“These delays were likely caused by a range of factors,” said Dr. Kapp. “Safety-net hospital populations generally have less access to childcare and transportation. Often, they do not have the type of employment that offers remote-work options, making their schedules less flexible. The pandemic may have exacerbated these issues. We also know this population became more disenfranchised during COVID.”

Dr. Kapp believes that proactive outreach is important to help safeguard the health of safety-net populations. Public service announcements, communications through primary care physicians, and telephone reminders all might help re-engage women in their health care.

“A pandemic and other ongoing situations that affect access to care can happen again,” Dr. Kapp concluded. “Patients at safety-net hospitals already are significantly disadvantaged and COVID set them back even more. We must make sure that this does not happen again.”