Department of Surgery, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
Department of Biomedical and Health Informatics, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
Ann Surg Oncol. 2022 Oct;29(10):6189-6196. doi: 10.1245/s10434-022-12139-2. Epub 2022 Aug 29.
COVID-19 disrupted health systems across the country. Pre-pandemic, patients accessing our urban safety-net hospital presented with three-fold higher rates of late-stage breast cancer than other Commission-on-Cancer sites. We sought to determine the effect of the COVID-19 pandemic on stage of breast cancer presentation and time to first treatment at our urban safety-net hospital.
An Institutional Review Board-approved cohort study of newly diagnosed breast cancer patients was conducted at our safety-net hospital comparing a COVID cohort (March 2020-February 2021, n = 82) with a pre-COVID cohort (March 2018-February 2019, n = 90). Demographic information, stage at presentation, and time to first treatment-subdivided into time from symptom to diagnosis and diagnosis to treatment-were collected and analyzed for effect of COVID pandemic.
Cohorts were similar in age, race, and payor. More patients had late-stage disease during COVID (32%) than pre-COVID (19%, p = 0.05). There was a significantly longer time to first treatment during COVID (p = 0.0001) explained by a significantly longer time from symptom to diagnosis (p = 0.0001), with no difference in time from diagnosis to treatment.
It was significantly more likely for patients to present to our safety-net hospital with late-stage breast cancer during COVID than pre-COVID. There was longer time to first treatment during COVID, driven by the increased time from symptom to diagnosis. Patients may have perceived that care was inaccessible during the pandemic or had competing priorities, driving delays. Efforts should be made to minimize disruption to safety-net hospitals during future shut-downs as these are among the most vulnerable patients.
COVID-19 扰乱了全国的医疗系统。在大流行之前，到我们城市的医疗保障医院就诊的患者中，晚期乳腺癌的发病率比其他癌症委员会指定的地点高出三倍。我们试图确定 COVID-19 大流行对我们城市医疗保障医院就诊的乳腺癌分期和首次治疗时间的影响。
对我们的医疗保障医院新诊断的乳腺癌患者进行了一项机构审查委员会批准的队列研究，比较了 COVID 队列（2020 年 3 月至 2021 年 2 月，n = 82）和 COVID 前队列（2018 年 3 月至 2019 年 2 月，n = 90）。收集了人口统计学信息、分期和首次治疗时间（分为从症状到诊断和诊断到治疗的时间），并进行了分析，以确定 COVID 大流行的影响。
两个队列在年龄、种族和支付者方面相似。在 COVID 期间，更多的患者患有晚期疾病（32%），而 COVID 前（19%），p = 0.05）。在 COVID 期间首次治疗的时间明显延长（p = 0.0001），这是由于从症状到诊断的时间明显延长（p = 0.0001），而从诊断到治疗的时间没有差异。
与 COVID 前相比，在 COVID 期间，患者更有可能到我们的医疗保障医院就诊时患有晚期乳腺癌。在 COVID 期间首次治疗的时间延长，这是由于从症状到诊断的时间延长所致。患者可能认为在大流行期间护理无法获得，或者有其他优先事项，导致延误。在未来的关闭期间，应努力尽量减少对医疗保障医院的干扰，因为这些医院是最脆弱的患者之一。
