The Impact of the COVID-19 Pandemic on the Diagnosis and Treatment of Breast Cancer at a Community Hospital

Background: The COVID-19 pandemic disrupted breast cancer care, potentially affecting diagnosis stage, time to treatment initiation, and treatment modalities. This study evaluated how pandemic-related restrictions affected these factors at a community hospital.

Methods: We conducted a retrospective review of electronic health records for 941 patients diagnosed with breast cancer. Patients were categorized by diagnosis time. We used Kruskal-Wallis tests to compare median time to first treatment by modality, COX proportional hazard models to analyze time to treatment in relation to diagnosis time period and clinical stage, and Chi-square tests to evaluate changes in modality of first treatment and cancer stage.

Results: Clinical stage at diagnosis varied significantly across time periods (P = .01), with more advanced stages during Peak-COVID and Post-Peak-COVID. Median time to first treatment increased during Peak-COVID (47 days) and Post-Peak-COVID (54 days) compared to Pre-COVID (38 days) (P < .001). Time to surgery as first treatment modality increased over the 3 periods (P < .001), while no significant differences were found for chemotherapy (P = .06) or hormone therapy (P = .28). The modality of first treatment shifted significantly (P < .001), with a decline in hormone therapy use during Peak-COVID, followed by an increase Post-Peak-COVID.

Conclusions: Our study highlights the pandemic's impact on breast cancer care, demonstrating significant differences in clinical stage at diagnosis, time to first treatment, and modality of first treatment. These disparities persisted into 2022, reflecting lasting effects of pandemic-related disruptions. Addressing these delays is essential for mitigating care gaps in future times of healthcare disruption.