ABSTRACT
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.
Subject(s)
Breast Neoplasms , COVID-19 , Humans , Female , Quality of Life , COVID-19/epidemiology , Breast Neoplasms/epidemiology , Breast Neoplasms/therapy , Surveys and Questionnaires , Delivery of Health CareABSTRACT
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.