Implications of protoco treatment delays for breast cancer patient during Covid-19

ABSTRACT

The Covid-19 pandemic put a considerable strain on U.S. healthcare resources, resulting in significant disruptions in breast cancer care. Treatment protocols across the cancer care continuum were modified to permit continued delivery of critical cancer care with the lowest risk of Covid-19 transmission for both patients and healthcare providers. These deviations from standard treatment protocols revealed to patients the complexity of navigating cancer treatment, including critical dependencies and care coordination. While much of the research on cancer treatment protocols during the pandemic focuses on effectiveness or health outcomes, this research investigates the experiences of breast cancer survivors as they navigated the uncertainties and complexities of their cancer care during the Covid-19 pandemic. Method: We conducted a qualitative content analysis of survey data documenting patient experiences of the impact of Covid-19 related disruptions in cancer care and the challenges of navigating breast cancer treatment during the pandemic. Data for this analysis come from a larger data set collected from a national survey of adult breast cancer survivors, distributed online from 4/2/20 to 4/27/20. We used snowball sampling to recruit adult (>18 years old) breast cancer survivors in the US. A 50-item survey instrument was administered to breast cancer survivors in the U.S to assess the impact of COVID-19 on breast cancer care. SResults: A total of 633 respondents completed the survey. We analyzed data from seven questions eliciting free-text responses detailing the nature of the delays in care and the impact of the delays on the physical, psycho-social, and practical aspects of life, yielding a sample size of 421 respondents. Patients reported experiencing a broad range of challenges across the cancer care continuum based on factors such as tumor type, disease stage, age, location and type of cancer care facility, and whether they were newly diagnosed, in active treatment, or completed active treatment. Respondents reported changes in the sequence, type, frequency, or location of treatment, follow-up, and symptom management. These changes were initiated by both providers and patients. Changes were associated with limited access to ancillary or supportive services such as imaging, labs, physical therapy and mental health care, and restricted availability of medical facilities such as operating rooms or emergency rooms. Balancing the risks of cancer and Covid-19 infection generated considerable uncertainty and anxiety for patients and their families, which they often attributed to feeling unable to reliably assess individual risk or prognosis. Respondents noted that navigating treatment protocol changes was further exacerbated by limitations on usual support services and resources, most notably restrictions prohibiting a companion or caregiver to accompany patients to appointments and changes in the frequency and channels of communication between survivors and their cancer care team. Conclusion: Our results point to the complex challenges and dependencies patient experienced in navigating cancer care during the Covid-19 pandemic. We suggest that a detailed understanding of patient experiences is critical to assessing the impact of the pandemic on cancer care, especially modifications to treatment protocols and other disruptions in care. These findings have implications beyond the crisis of the pandemic and can inform interventions to improve care coordination and communication between patients and providers and identify evidence-based opportunities to enhance breast cancer support and patient navigation in the U.S.