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

doi:10.1007/s10549-021-06362-w

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

Breast Cancer Res Treat. 2021 Nov;190(2):287-293. doi: 10.1007/s10549-021-06362-w. Epub 2021 Sep 13.

Authors

A Dilawari^{1

2}, K E Rentscher^{3

4}, W Zhai^{2

5}, X Zhou^{2

5}, T A Ahles⁶, J Ahn³, T N Bethea², J E Carroll^{4

5}, H J Cohen⁷, D A Graham⁸, H S L Jim⁹, B McDonald¹⁰, Z M Nakamura¹¹, S K Patel¹², J C Root⁶, B J Small¹³, A J Saykin¹⁰, D Tometich⁹, K Van Dyk⁵, J S Mandelblatt¹⁴; Thinking and Living with Cancer Study

Affiliations

¹ Medstar Washington Hospital Center, Washington, DC, 20007, USA.
² Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Blvd, Suite 4100, Washington, DC, USA.
³ Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, USA.
⁴ Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
⁵ Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA.
⁶ Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁷ Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
⁸ John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA.
⁹ Moffitt Cancer Center, Tampa, FL, USA.
¹⁰ Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA.
¹¹ Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
¹² City of Hope National Medical Center, Los Angeles, CA, USA.
¹³ University of South Florida, Tampa, FL, USA.
¹⁴ Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Blvd, Suite 4100, Washington, DC, USA. mandelbj@georgetown.edu.

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.

MeSH terms

Aged
Aged, 80 and over
Breast Neoplasms* / epidemiology
Breast Neoplasms* / therapy
COVID-19*
Cancer Survivors*
Female
Humans
Middle Aged
Pandemics
SARS-CoV-2

Associated data

ClinicalTrials.gov/NCT03451383

Abstract

MeSH terms

Associated data

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