ABSTRACT
Background: The COVID-19 pandemic influenced patient health care decisions, but there is little information about the pandemic's impact on decisions about cancer risk reduction. This includes women at elevated risk of breast or ovarian cancer considering risk-reducing salpingooophorectomy (RRSO), risk-reducing salpingectomy (RRS), or other preventive measures. During the pandemic patients needed to balance their concerns about cancer risk reduction with their risks associated with elective health procedures, a risk which changed as vaccines became available. Method(s): To address the impact of the COVID-19 pandemic on cancer prevention decision making, we recruited N=396 pre-menopausal women with a personal history of breast cancer or familial history suggestive of increased breast and/or ovarian cancer risk between 4/2019 and 3/2022. We conducted a discrete choice experiment in which patients were asked to choose between two scenarios that specified type of surgery (RRSO, RRS vs. non-surgical surveillance), age of menopause (natural versus immediate), quality of menopausal symptoms (mild, moderate, severe), and risk of ovarian cancer, heart disease, or osteoporosis. Risk of ovarian cancer for the scenarios provided varied in discrete intervals from 0% to 40%. We examined temporal trends during the pandemic using interactions with time coinciding approximately with the beginning of pandemic, peak vaccination period, and the Omicron wave. Result(s): We identified significant temporal interactions on a woman's prevention decisions. In 2019, women at higher risk of ovarian cancer were more likely to choose prevention scenarios that favored lower ovarian cancer risk (odds ratio [OR] = 0.48;95% CI = 0.37, 0.69 per 10% increase in ovarian cancer risk difference). This association decreased through the pre-vaccine period of 2020 by OR=2.61/month (95% CI = 1.21, 5.65). By June 2020, the effect of a 10% increase in ovarian cancer risk on intervention choice had attenuated substantially (OR=0.84, 95% CI 0.67, 1.00). By January 2022, the effect strengthened (OR= 0.69, 95% CI .49, .88), but had not reached pre-pandemic levels. Before 3/2020, natural age of menopause (versus immediate) had a strong impact on the choice of a scenario (OR=3.56, 95% CI 1.65-7.65). At the beginning of the pandemic, the effect was reduced by 0.47/month (95% CI 0.22-0.99). The rate of attenuation slowed over time, such that the effect of having a natural age of menopause on choice was OR= 1.56 (95% CI 0.65, 2.46) by January 2022. Tests for temporal interactions were statistically significant for both ovarian cancer risk and age of menopause. Conclusion(s): Our results suggest that over the course of the pandemic, women seemed more accepting of higher risks of ovarian cancer and immediate (post treatment) menopause when considering preventive options. There was an inverse U shape curve of the effect of ovarian cancer risk on choices over time (Figure A), but the strength of the relationship had not reached prepandemic levels by January 2022. This may reflect patient tolerance for side effects as the pandemic evolved. These results suggest that factors such as ovarian cancer risk and delay of menopause influenced personal prevention choices, but that these choices were influenced by events related to events that hallmarked the COVID-19 pandemic.
ABSTRACT
The COVID-19 pandemic profoundly affected cancer prevention behaviors and cancer care. Social capital is also thought to affect cancer prevention and care, with some observed improvements in well being and survival among cancer patients. Residents of immigrant enclaves are thought to have more social capital than non-residents, potentially buffering against negative effects of the pandemic. We compared residents and non-residents of Chinese immigrant enclaves in Philadelphia with respect to their social capital and loneliness and change in these factors from before to during the pandemic. Participants were 520 Chinese immigrant men and women aged 3565 y. Baseline interviews conducted 9/18-01/20 included questions on residence and demographics, structural and cognitive social capital (short version of the Adapted Social Capital Assessment Tool (SASCAT)), and a validated 3-item loneliness scale. The SASCAT includes questions on membership in neighborhood groups, receiving support from specific individuals (e.g., family, neighbors, friends), and cognitive social capital representing perceived levels of trust and belonging in the neighborhood. In May-July 2020, 419 participants completed a follow-up interview that included the SASCAT and loneliness scales. Participants were categorized as residing in a traditional, emerging, or non-enclave neighborhood depending on the ethnic density of their census tract and adjacent tracts. At baseline there were no significant differences in social capital or loneliness across neighborhood types. During the pandemic, participants regardless of neighborhood type reported declines in group membership (18% baseline vs. 11% pandemic) and loneliness (25% vs. 12%), and increases in cognitive social capital (85% vs. 99%) and receiving support from individuals (35% vs. 69%) (all p<0.001). However, extent of change differed by neighborhood, resulting in significantly less loneliness among residents of traditional enclaves (5%) than in emerging (14%) and non-enclave (16%) residents (p=0.02) during the pandemic. Multivariate analyses using generalized estimating equation models indicated that residents of traditional enclaves experienced a larger decrease in loneliness than other participants (interaction p=0.009), and that residents of traditional and emerging enclaves experienced a larger increase in cognitive social capital than residents of non-enclaves (interaction p=0.03). Our findings provide evidence that while the pandemic may have effected declines in group membership in this sample of Chinese immigrants, it was associated with increases in other forms of social capital and with a decrease in loneliness, particularly among enclave residents. These findings suggest the importance of clarifying how social capital derived from interacting within an immigrant enclave might be leveraged to counter the effects of a community stressor such as the COVID-19 pandemic, and used towards positive cancer outcomes in these communities.