One year of COVID-19 restrictions resulted in serious delays in diagnosis and treatment of women at an urban safety net hospital, the lead author of a study told the 23rd Annual Meeting of the American Society of Breast Surgeons in Las Vegas in April.
Stay-at-home recommendations and postponement from the CDC resulted in later stages of breast cancer stage at presentation and time to treatment, said Kelly Kapp, MD, PGY-4 General Surgery Resident at University of Missouri-Kansas City School of Medicine. She and her colleagues reviewed data from the institution's breast cancer registry on 82 patients diagnosed with breast cancer from March 2020 to April 2021, comparing the data with 90 women treated 1 year before the COVID lockdown.
In March 2020, the CDC recommended postponing elective surgeries and medical procedures. Although surgeries for cancer continued, screening mammograms declined, she noted.
"We hypothesized that the pandemic would cause delays across all parameters studied, and our research corroborates this," Kapp shared during a press briefing. "Given that our population already had a history of presenting with three-fold higher rates of late-stage cancer pre-pandemic, the increased risk and the implications for care and outcomes are enormous."
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. Moreover, the mean time to first treatment was 48 days compared to 29 days pre-COVID, and mean time to surgery, when it was the first treatment, was 65 days during COVID compared to 36 days pre-COVID.
Even before the pandemic, patients accessing the hospital presented with three-fold higher rates of late-stage breast cancer than other accredited sites across the country, Kapp said, adding that COVID delays were likely caused by a range of factors.
"Safety net hospital populations generally have less access to child care 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."
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," Kapp commented. "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."
Study Details
Both sets of patients had similar baseline characteristics, but those in the COVID group were more likely to present with late-stage disease than did women diagnosed before the outbreak-31.7 percent versus 18.9 percent. Analysis controlling for race and insurance showed that it was 1.2 times more likely for safety net women to present with late-stage disease during COVID restrictions as compared to those who presented pre-COVID (p<0.05). There was longer time to first treatment and longer time to surgery (when surgery was the first treatment) during COVID than pre-COVID (median 48 days vs. 29 days to first treatment; median 65 days vs. 36 days to surgery).
"Here we have shown that the pandemic further exacerbated this problem among safety net women, making it significantly more likely that they presented with late-stage breast cancer and longer times to first treatment, including surgery.
"Reasons for this are likely multifactorial. Institutional factors alone do not account for the delay since clinics were only briefly closed and cancer surgeries never stopped, although screening mammograms did. There may have been a perception on the part of patients that care was not accessible during this time, and stressors and competing priorities may have contributed to delays in seeking care. Every effort should be made to minimize disruption to safety net hospitals during future shutdowns or public health crises, as these patients are already among our most vulnerable."
Kurt Samson is a contributing writer.