Medical care disruptions during the first six months of the COVID-19 pandemic: the experience of older breast cancer survivors

A Dilawari, K E Rentscher, W Zhai, X Zhou, T A Ahles, J Ahn, T N Bethea, J E Carroll, H J Cohen, D A Graham, H S L Jim, B McDonald, Z M Nakamura, S K Patel, J C Root, B J Small, A J Saykin, D Tometich, K Van Dyk, J S Mandelblatt, Thinking and Living with Cancer Study, A Dilawari, K E Rentscher, W Zhai, X Zhou, T A Ahles, J Ahn, T N Bethea, J E Carroll, H J Cohen, D A Graham, H S L Jim, B McDonald, Z M Nakamura, S K Patel, J C Root, B J Small, A J Saykin, D Tometich, K Van Dyk, J S Mandelblatt, Thinking and Living with Cancer Study

Abstract

Purpose: Older cancer survivors required medical care during the COVID-19 pandemic, but there are limited data on medical care in this age group.

Methods: We evaluated care disruptions in a longitudinal cohort of non-metastatic breast cancer survivors aged 60-98 from five US regions (n = 321). Survivors completed a web-based or telephone survey from May 27, 2020 to September 11, 2020. Care disruptions included interruptions in seeing or speaking to doctors, receiving medical treatment or supportive therapies, or filling prescriptions since the pandemic began. Logistic regression models evaluated associations between care disruptions and education, medical, psychosocial, and COVID-19-related factors. Multivariate models included age, county COVID-19 death rates, comorbidity, and post-diagnosis time.

Results: There was a high response rate (n = 262, 81.6%). Survivors were 32.2 months post-diagnosis (SD 17.5, range 4-73). Nearly half (48%) reported a medical disruption. The unadjusted odds of care disruptions were higher with each year of education (OR 1.22, 95% CI 1.08-1.37, p = < 0.001) and increased depression by CES-D score (OR 1.04, CI 1.003-1.08, p = 0.033) while increased tangible support decreased the odds of disruptions (OR 0.99, 95% CI 0.97-0.99, p = 0.012). There was a trend between disruptions and comorbidities (unadjusted OR 1.13 per comorbidity, 95% CI 0.99-1.29, p = 0.07). Adjusting for covariates, higher education years (OR1.23, 95% CI 1.09-1.39, p = 0.001) and tangible social support (OR 0.98 95% CI 0.97-1.00, p = 0.006) remained significantly associated with having care disruptions.

Conclusion: Older breast cancer survivors reported high rates of medical care disruptions during the COVID-19 pandemic and psychosocial factors were associated with care disruptions. CLINICALTRIALS.

Gov identifier: NCT03451383.

Keywords: Breast cancer; COVID; Cancer survivors; Medical care disruptions; Older adults.

Conflict of interest statement

AAD attended the Cardinal Health 2020 Advisor Board Oncology Committee. HSJ: Consulting or Advisory Role: Janssen Pharmaceuticals and RedHill Biopharma. DG: Stock and Other Ownership Interests: Cota. AJS: Consulting or Advisory Role: Bayer AG Research Funding: Eli Lilly (Inst).

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Figures

Fig. 1
Fig. 1
A sample for evaluation of medical disruptions in older breast cancer survivors. Participants were excluded if they were not active (i.e., had completed the study, dropped out, or deceased) since the start of survey data collection. The percentage who completed and refused was calculated among those active and eligible to complete the survey. 1Participants were ineligible if they had a COVID-19 diagnosis or were missing information about chemotherapy or hormonal treatment for breast cancer

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