SurvivingBreastCancer.org, Boston, MA 02119, USA.
Mongan Institute, Clinical Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA 02114, USA.
Curr Oncol. 2022 Aug 20;29(8):5919-5932. doi: 10.3390/curroncol29080467.
PURPOSE: To evaluate and quantify potential sociodemographic disparities in breast cancer screening, diagnosis, and treatment due to the COVID-19 pandemic, and the use of telemedicine. METHODS: We fielded a 52-item web-based questionnaire from 14 May 2020 to 1 July 2020 in partnership with several U.S.-based breast cancer advocacy groups. Individuals aged 18 or older were eligible for this study if they: (1) received routine breast cancer screening; OR (2) were undergoing diagnostic evaluation for breast cancer; OR (3) had ever been diagnosed with breast cancer. We used descriptive statistics to understand the extent of cancer care delay and telemedicine adoption and used multivariable logistic regression models to estimate the association of sociodemographic factors with odds of COVID-19-related delays in care and telemedicine use. RESULTS: Of 554 eligible survey participants, 493 provided complete data on demographic and socioeconomic factors and were included in the analysis. Approximately half (n = 248, 50.3%) had a personal history of breast cancer. Overall, 188 (38.1%) participants had experienced any COVID-19-related delay in care including screening, diagnosis, or treatment, and 339 (68.8) reported having at least one virtual appointment during the study period. Compared to other insurance types, participants with Medicaid insurance were 2.58 times more likely to report a COVID-19-related delay in care (OR 2.58, 95% Cl: 1.05, 6.32; = 0.039). Compared to participants with a household income of less than USD 50,000, those with a household income of USD 150,000 or more were 2.38 (OR 2.38, 95% Cl: 1.09, 5.17; = 0.029) times more likely to adopt virtual appointments. Self-insured participants were 70% less likely to use virtual appointment compared to those in other insurance categories (OR 0.28, 95% Cl: 0.11, 0.73; = 0.009). CONCLUSIONS: The COVID-19 pandemic has had a significant impact on breast cancer screening, diagnosis, and treatment, and accelerated the delivery of virtual care. Lower-income groups and patients with certain insurance categories such as Medicaid or self-insured could be more likely to experience care delay or less likely to use telemedicine. Careful attention must be paid to vulnerable groups to insure equity in breast cancer-related service utilization and telemedicine access during and beyond the COVID-19 pandemic.
目的：评估和量化 COVID-19 大流行和远程医疗使用导致的乳腺癌筛查、诊断和治疗方面潜在的社会人口统计学差异。
方法：我们于 2020 年 5 月 14 日至 7 月 1 日与几家美国乳腺癌倡导组织合作，通过在线问卷调查的方式收集数据。如果参与者满足以下条件，则有资格参与本研究：（1）接受常规乳腺癌筛查；或（2）正在接受乳腺癌诊断评估；或（3）曾被诊断患有乳腺癌。我们使用描述性统计来了解癌症护理延迟和远程医疗采用的程度，并使用多变量逻辑回归模型来估计社会人口统计学因素与 COVID-19 相关护理延迟和远程医疗使用的可能性之间的关联。
结果：在 554 名符合条件的调查参与者中，有 493 名提供了完整的人口统计学和社会经济因素数据，并纳入了分析。大约一半（n=248，50.3%）有乳腺癌个人病史。总体而言，188 名（38.1%）参与者经历了任何与 COVID-19 相关的护理延迟，包括筛查、诊断或治疗，339 名（68.8%）报告在研究期间至少有一次虚拟预约。与其他保险类型相比，有医疗补助保险的参与者报告 COVID-19 相关护理延迟的可能性高 2.58 倍（OR 2.58，95%Cl：1.05，6.32； = 0.039）。与家庭收入低于 50000 美元的参与者相比，家庭收入为 150000 美元或以上的参与者采用虚拟预约的可能性高 2.38 倍（OR 2.38，95%Cl：1.09，5.17； = 0.029）。与其他保险类别的参与者相比，自付保险的参与者使用虚拟预约的可能性低 70%（OR 0.28，95%Cl：0.11，0.73； = 0.009）。
结论：COVID-19 大流行对乳腺癌筛查、诊断和治疗产生了重大影响，并加速了虚拟护理的发展。低收入群体和某些保险类别的患者（如医疗补助或自付保险）可能更容易出现护理延迟，或不太可能使用远程医疗。在 COVID-19 大流行期间及之后，必须密切关注弱势群体，以确保在乳腺癌相关服务利用和远程医疗获取方面的公平性。
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