Cancer causes & control : CCC · 2025
Patterns of care and treatment delays among patients with early-stage breast cancer: long term impact of the COVID-19 (C19) pandemic.
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Jackson Inimfon, Sullivan Marija, Lei Xiudong, Giordano Sharon H, Chavez-MacGregor Mariana
Аннотация
PURPOSE: To assess the long-term impact of the COVID-19 (C19) pandemic, we examined treatment patterns and delays in early-stage breast cancer (BC).
METHODS: Patients ≥ 18 years with clinical stage I-III BC diagnosed between 2019 and 2022 were identified in the National Cancer Database. Patients were categorized as pre-C19 (2019), early-C19 (2020), late-C19 (2021), and post-C19 (2022). Descriptive statistics assessed changes in early-stage BC treatment patterns and time-to-treatment initiation. Multivariable logistic regression was used to identify factors associated with treatment delays > 60 days.
RESULTS: A decline in BC cases was observed during the pre- to early-C19 period, it was more pronounced among patients with stage I disease. While surgery as initial treatment decreased from pre- to post-C19, chemotherapy use increased. The early-C19 period was associated with lower odds of any treatment initiation delays > 60 days (adjusted odds ratio [aOR] = 0.87; 95% CI 0.85-0.89) while late-C19 (aOR = 1.20; 95% CI 1.17-1.22) and post-C19 (aOR = 1.46; 95% CI 1.43-1.49) were associated with higher odds compared to pre-C19. Black (aOR = 1.59; 95% CI 1.55-1.63) and Hispanic (aOR = 1.57; 95% CI 1.53-1.61) patients were more likely to have any treatment initiation delays.
CONCLUSIONS: The C19 pandemic disrupted BC care, contributing to ongoing treatment delays. Future studies are needed to understand how systemic factors impact long-term outcomes.
METHODS: Patients ≥ 18 years with clinical stage I-III BC diagnosed between 2019 and 2022 were identified in the National Cancer Database. Patients were categorized as pre-C19 (2019), early-C19 (2020), late-C19 (2021), and post-C19 (2022). Descriptive statistics assessed changes in early-stage BC treatment patterns and time-to-treatment initiation. Multivariable logistic regression was used to identify factors associated with treatment delays > 60 days.
RESULTS: A decline in BC cases was observed during the pre- to early-C19 period, it was more pronounced among patients with stage I disease. While surgery as initial treatment decreased from pre- to post-C19, chemotherapy use increased. The early-C19 period was associated with lower odds of any treatment initiation delays > 60 days (adjusted odds ratio [aOR] = 0.87; 95% CI 0.85-0.89) while late-C19 (aOR = 1.20; 95% CI 1.17-1.22) and post-C19 (aOR = 1.46; 95% CI 1.43-1.49) were associated with higher odds compared to pre-C19. Black (aOR = 1.59; 95% CI 1.55-1.63) and Hispanic (aOR = 1.57; 95% CI 1.53-1.61) patients were more likely to have any treatment initiation delays.
CONCLUSIONS: The C19 pandemic disrupted BC care, contributing to ongoing treatment delays. Future studies are needed to understand how systemic factors impact long-term outcomes.