Impact of COVID-19 on health care and quality of life in women with breast cancer.

BACKGROUND: The aims of this study were to explore the impact of COVID-19 on health-care services and quality of life (QoL) in women diagnosed with breast cancer (BC) in Ireland and whether the impact varied by social determinants of health (SDH). METHODS: Women diagnosed with BC completed a questionnaire measuring the impact of COVID-19, disruption to BC services, QoL, SDH, and clinical covariates during COVID-19 restrictions. The association between COVID-19 impact and disruption to BC services and QoL was assessed using multivariable regression with adjustment for SDH and clinical covariates. An interaction between COVID-19 impact and health insurance status was assessed within the regression models. RESULTS: A total of 30.5% (n = 109) of women reported high COVID-19 impact, and these women experienced more disruption in BC services (odds ratio = 4.95, 95% confidence interval = 2.28 to 10.7, P < .001) and lower QoL (ß = -12.01, SE = 3.37, P < .001) compared with women who reported low COVID-19 impact. Health insurance status moderated the effect of COVID-19 on disruption to BC services and QoL. Women who reported high COVID-19 impact experienced more disruption to BC services and lower QoL compared with women with low COVID-19 impact; however, the magnitude of these unfavorable effects differed by insurance status (Pinteraction < .05). CONCLUSIONS: There was a large disruption to BC services and decrease in QoL for women with BC in Ireland during the pandemic. However, the impact was not the same for all women. It is important that women with BC are reintegrated into proper care and QoL is addressed through multidisciplinary support services.

COVID-19 and breast cancer care in Ireland: a survey study to investigate the impact of the pandemic on breast cancer services

BackgroundSince the start of the COVID-19 pandemic, health services for non-communicable diseases (NCDs) have been significantly disrupted. Individuals living with NCDs, including cancer, are classified as vulnerable because of the disruption in health services and potentially compromised health status. Breast cancer (BC) is the most common cancer for women in Ireland and the impact of the pandemic on BC care is largely unknown. The aim of this study is to understand the immediate impact of the pandemic on health care utilisation for women living with and beyond BC in Ireland.MethodsThe cross-sectional study included questionnaires distributed during COVID-19 lockdown restrictions, starting October 2020. Women diagnosed with BC in the past 5 years were eligible to participate and data was collected either online or through surveys distributed from hospitals. Descriptive statistics on impacted health services were analysed and results are presented as percentages and confidence intervals (CI).ResultsThe final study size was N=387. Most women were between 50 and 64 years of age (51.7%, N=194) and many women resided in County Dublin (43.7%, N=163). 95% of women (N=357, 95% CI [92–97]) either tested negative for COVID-19 or never believed to have contracted COVID-19. 27% (N=103, 95% CI [22 -31]) of women were undergoing BC treatment (surgery, chemotherapy and/or radiotherapy) and of these women, 25% (N=26, 95% CI [17- 35]) reported a cancellation or postponement of treatment. 43% (N=166, 95% CI [38 -48]) of women had planned future treatment and of these women, 49% (N=81, 95% CI [41–57]) reported a cancellation or postponement of treatment. 45.2% (N=159, 95% CI [40 -51]) of all women reported a cancelled or postponed follow-up appointment. Furthermore, 71% of women (N=275, 95% CI [67 -76]) experienced a remote appointment, and of those women, 62% (N=170, 95% CI [57- 69]) were satisfied with the appointment.ConclusionThis study identifies the impact of the pandemic on BC services. In conclusion, there has been a large disruption to BC services during the pandemic, including active treatment and post-active treatment. Further research is needed to understand how the health system in Ireland has responded since the outbreak of COVID-19.

‘Everyone should know what they’re on’: a qualitative study of attitudes towards and use of patient held lists of medicines among patients, carers and healthcare professionals in primary and secondary care settings in Ireland

ObjectivesManaging multiple medicines can be challenging for patients with multimorbidity, who are at high risk of adverse outcomes, for example, hospitalisation. Patient-held medication lists (PHMLs) can contribute to patient safety and potentially reduce medication errors. The aims of this study are to investigate attitudes towards and use of PHMLs among healthcare professionals (HCPs), patients and carers.DesignQualitative study based on 39 semistructured telephone interviews.SettingPrimary and secondary care settings in Ireland.ParticipantsTwenty-one HCPs and 18 people taking medicines and caregivers.MethodsTelephone interviews were conducted with HCPs, people taking multiple medicines (5+ medicines) and carers of people taking medicines who were purposively sampled via social media, patient groups and research collaborators. Interviews were transcribed and thematically analysed based on the Framework approach, with the Consolidated Framework for Implementation Research and Theoretical Domains Framework.ResultsThree core themes emerged: (1) attitudes to PHML, (2) function and preferred features of PHML and (3) barriers and facilitators to future use of PHML. All participating (patients/carers and HCP) groups considered PHML beneficial for patients and HCPs (eg, empowering for patients and improved adherence). While PHML were used in a variety of situations such as emergencies, concerns about their accuracy were shared across all groups. HCPs and patients differed on the level of detail that should be included in PHML. HCPs’ time constraints, patients’ multiple medicines and cognitive impairments were reported barriers. Key facilitators included access to digital/compact lists and promotion of lists by appropriate HCPs.ConclusionsOur findings provide insight into the factors that influence use of PHML. Lists were used in a variety of settings, but there were concerns about their accuracy. A range of list formats and encouragement from key HCPs could increase the use of PHML.