Change in practice of RRSO consults and procedures during the COVID-19 pandemic (563)

Objectives: To investigate the impact of the Covid-19 pandemic on risk-reducing salpingo-oophorectomies (RRSO). Methods: An electronic survey was sent out to 1,127 full members of the Society of Gynecologic Oncology in August 2021. Survey data included physician characteristics, practice location, and self-reported subjective and objective data about their RRSOs and consults. Results: We received 69 responses from US gynecologic oncologists. Two-thirds of respondents were female;the mean age of respondents was 46 years (range: 35-65). Most respondents performed 10-20 RRSOs per year (median: 15, range: 2-75). During the pandemic, 76% of providers delayed RRSOs, and currently, 11% are delaying these surgeries. From March 2020, to February 2021, most providers (86%) transitioned some RRSO consults to telehealth. There was no correlation between uptake of telemedicine by age (R2=0.09) or gender (p=0.80). Those in the West Coast region reported significantly more use of telemedicine than in the Southwest (p<0.01) and Southeast (p<0.01). Providers using telemedicine spent more time with patients in-person than compared to virtually (37 min vs 33 min, p=.005). Sexual function was discussed almost 100% of the time during inperson (median: 100%, range: 10-100) and telehealth (median: 100%, range: 10-100) visits. We found female providers reduced their time discussing sexual function from in-person to telehealth visits from 7.5 to 5.7 minutes (p<0.01), but male providers reported equal time with both modalities (6.0 min). No difference between females and males was noted during in-person (p=0.74) or telehealth visits (p=0.10). Physicians ranked discussing sexual function 7/10 on a priority scale. Topics included (by decreasing frequency) menopausal symptoms, vaginal dryness, decreased libido, and dyspareunia. Barriers to virtual discussions were not being queued by the pelvic exam (30%) and confirming patient privacy (26%). Notably, providers reported that patients felt comfortable and safe via telehealth. Providers reported they perform the majority of RRSOs with multiport laparoscopy (mean 78% of cases), though single port and robotics were common. A wide range of practice regarding the performance of hysterectomy with RRSO was noted: 2% of respondents performed hysterectomies with every RRSO, while 9% rarely performed them. Conclusions: Overall, telemedicine is now commonly used for RRSO consults. While many of these cases were delayed early in the pandemic, few providers are still delaying RRSO. A wide variety of practice was noted regarding surgical modality for RRSO and performance of hysterectomy. The use of telemedicine does not seem to inhibit discussions of sexual function, and most providers discuss sexual health in every RRSO consult. Importantly, the loss of the pelvic exam or private setting did not affect the time providers spent discussing sexual health.

Breast cancer diagnosis and treatment during the COVID-19 pandemic in a nationwide, insured population.

PURPOSE: The early months of the COVID-19 pandemic led to reduced cancer screenings and delayed cancer surgeries. We used insurance claims data to understand how breast cancer incidence and treatment after diagnosis changed nationwide over the course of the pandemic. METHODS: Using the Optum Research Database from January 2017 to March 2021, including approximately 19 million US adults with commercial health insurance, we identified new breast cancer diagnoses and first treatment after diagnosis. We compared breast cancer incidence and proportion of newly diagnosed patients receiving pre-operative systemic therapy pre-COVID, in the first 2 months of the COVID pandemic and in the later part of the COVID pandemic. RESULTS: Average monthly breast cancer incidence was 19.3 (95% CI 19.1-19.5) cases per 100,000 women and men pre-COVID, 11.6 (95% CI 10.8-12.4) per 100,000 in April-May 2020, and 19.7 (95% CI 19.3-20.1) per 100,000 in June 2020-February 2021. Use of pre-operative systemic therapy was 12.0% (11.7-12.4) pre-COVID, 37.7% (34.9-40.7) for patients diagnosed March-April 2020, and 14.8% (14.0-15.7) for patients diagnosed May 2020-January 2021. The changes in breast cancer incidence across the pandemic did not vary by demographic factors. Use of pre-operative systemic therapy across the pandemic varied by geographic region, but not by area socioeconomic deprivation or race/ethnicity. CONCLUSION: In this US-insured population, the dramatic changes in breast cancer incidence and the use of pre-operative systemic therapy experienced in the first 2 months of the pandemic did not persist, although a modest change in the initial management of breast cancer continued.

The Impact of COVID-19 on Patients With Cancer: A National Study of Patient Experiences.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic abruptly disrupted cancer care. The impact of these disruptions on patient experiences remain relatively understudied. The objective of this study was to assess patients' perspectives regarding the impact of COVID-19 on their experiences, including their cancer care, emotional and mental health, and social determinants of health, and to evaluate whether these outcomes differed by cancer stage. MATERIALS AND METHODS: We conducted a survey among adults with cancer across the United States from April 1, 2020 to August 26, 2020 using virtual snowball sampling strategy in collaboration with professional organizations, cancer care providers, and patient advocacy groups. We analyzed data using descriptive statistics, χ2 and t tests. RESULTS: Three hundred twelve people with cancer participated and represented 38 states. The majority were non-Hispanic White (n=183; 58.7%) and female (n=177; 56.7%) with median age of 57 years. Ninety-one percent spoke English at home, 70.1% had health insurance, and 67% had access to home internet. Breast cancer was the most common diagnosis (n=67; 21.5%). Most had Stage 4 disease (n=80; 25.6%). Forty-six percent (n=145) experienced a change in their care due to COVID-19. Sixty percent (n=187) reported feeling very or extremely concerned that the pandemic would affect their cancer and disproportionately experienced among those with advanced cancer stages compared with earlier stages (P<0.001). Fifty-two percent (n=162) reported impact of COVID-19 on 1 or more aspects of social determinants of health with disproportionate impact among those with advanced cancer stages compared with earlier stages. CONCLUSIONS: COVID-19 impacted the care and well-being of patients with cancer and this impact was more pronounced among people with advanced cancer stages. Future work should consider tailored interventions to mitigate the impact of COVID-19 on patients with cancer.

Widening cancer care disparities in the adoption of telemedicine during COVID 19: who is left behind?

To determine the racial disparities in oncology visits of racial minorities before and after COVID-19. Data were obtained from the electronic health records, a multi-specialty healthcare system serving a racially/ethnically diverse patient population in northern California. The study cohort included patients who had at least one oncology visit from January 2019 to August 2020. We examined the trends in the volume of oncology office visits and adoption of video visits during the ongoing COVID-19 pandemic period. Chi-square test and multivariate logistic regression were performed to examine variability in use of video visits by specific patient characteristics (sex, age, race/ethnicity and language barrier). Of 63,903 cancer patients (median age: 66;68% female), Whites, Blacks, Hispanics, Asians and others composed of 64.8%, 3.5%, 9.2%, 11.7% and 10.8% of our study cohort. Over the 20 month study period, the drop in in-person visits began in March and peaked in April 2020. Compared to the year 2019, the office visits decreased by -16.6%, -55.9%, and -50.9% in March, April, and May of 2020. Although there was a trend towards increased office visits in June (-21.9% compared to 2019), this again decreased to -35% in July 2020. The proportion of visits conducted by video began at 16.6% in the first week after California's shelter-in-place order in March, peaked at a high rate of 43.4% in April, and remained at a rate of 33.8% in August. We focused on variability by specific patient subgroups when telemedicine was offered and used prevalently during early pandemic in April. Based on age, the younger cohorts, 18-50 and 51-64 year olds, were more likely to utilize video visit at 50.6%, and 50.6% compared to only 38.0% and 36.7% of the older groups (65-75 and 76+ years old, p<0.001). In fact, the largest discrepancy, 21% difference between the younger vs older groups, was observed towards the end of April. With respect to race, Asians had the highest use of video visits (51.4%) compared to Hispanic (34.5%) and Black patients (40.3%) in April (p<0.001). Although the gap narrowed over the next 4 months with only a 4% difference by August, these cancelled visits were not recovered in the minority groups. Finally, 44.6% of those who did not require an interpreter utilized video visits as compared to only 19.8% who did require an interpreter (p<0.001). Age and race/ethnicity remain strong predictors of video visit use after adjusting the main and interaction effects of patient characteristics, with Asians 51-64 year old having the highest rate (58%) and Hispanics 76+ year old the lowest rate (30%). Overall office visits have decreased significantly during the COVID-19 pandemic. Older patients, Black patients, Hispanic patients, and patients who required interpreting services were less likely to be treated through video visits. Future studies are needed to better understand the barriers to telemedicine care. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Impact of the COVID-19 Pandemic on Breast Cancer Mortality in the US: Estimates From Collaborative Simulation Modeling.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has disrupted breast cancer control through short-term declines in screening and delays in diagnosis and treatments. We projected the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. METHODS: Three established Cancer Intervention and Surveillance Modeling Network breast cancer models modeled reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact. RESULTS: By 2030, the models project 950 (model range = 860-1297) cumulative excess breast cancer deaths related to reduced screening, 1314 (model range = 266-1325) associated with delayed diagnosis of symptomatic cases, and 151 (model range = 146-207) associated with reduced chemotherapy use in women with hormone positive, early-stage cancer. Jointly, 2487 (model range = 1713-2575) excess breast cancer deaths were estimated, representing a 0.52% (model range = 0.36%-0.56%) cumulative increase over breast cancer deaths expected by 2030 in the absence of the pandemic's disruptions. Sensitivity analyses indicated that the breast cancer mortality impact would be approximately double if the modeled pandemic effects on screening, symptomatic diagnosis, and chemotherapy extended for 12 months. CONCLUSIONS: Initial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. Continued efforts to ensure prompt return to screening and minimize delays in evaluation of symptomatic women can largely mitigate the effects of the initial pandemic-associated disruptions.