Patient Perceptions of Changes in Breast Cancer Care and Well-Being During COVID-19: A Mixed Methods Study

Abstract

Background: Widespread healthcare restructuring due to the COVID-19 pandemic led to modifications in the timing and delivery of care for breast cancer patients. Our study explores patient concerns relating to COVID-19, breast cancer, and changes to breast cancer care.

Patients and methods: Breast cancer patients who presented for surgical consultation at an academic, multidisciplinary clinic completed the electronically distributed validated COVID-19 Impact and Healthcare Related Quality of Life questionnaire between August 2020 and February 2021. This questionnaire uses Likert score responses to assess COVID-specific concerns within domains, including distress and financial hardship. Scale scores were determined by averaging items within each domain, and scores > 2 indicated greater disruption. Semistructured interviews were conducted with patients who indicated interest in participating in the questionnaire.

Results: Of 381 patients recruited, 133 patients completed the questionnaire and 20 patients completed interviews. Sixty-three percent of survey participants reported attending a telemedicine appointment for their cancer care, and the majority (67%) were satisfied with their experience. Half of the participants (50%) reported fear about how the COVID-19 pandemic will impact their cancer care or recovery, and 66% reported anxiety about contracting COVID-19. Twenty-two percent of participants reported decreased income due to COVID-19. Patient interviews revealed tangible changes to care and provided in-depth information on the advantages and disadvantages of telehealth.

Conclusions: Breast cancer patients report anxiety about COVID-19 infection and potential care modifications. Our study identifies impacts on patients' care and quality of life. Further investigation will inform interventions to improve psychosocial outcomes for patients and the telehealth experience.

Fig. 1

COVID-19 and healthcare items from the COVID-19 IHRQL questionnaire: Patients rated their agreement to a set of statements on the COVID-19 IHRQL questionnaire using a Likert scale, ranging from strongly disagree to strongly agree

Fig. 2

Practical concerns from the COVID-19 IHRQL questionnaire: Patients rated their agreement to a set of statements on the COVID-19 IHRQL questionnaire using a Likert score response, ranging from 0 (strongly disagree) to 4 (strongly agree)

Fig. 3

Representative quotes on visitor limitations: Patients participated in semistructured interviews and their responses were transcribed verbatim. Representative quotes relating to visitor limitations at various points in care were selected

Fig. 4

Representative quotes on telehealth experience: Patients participated in semistructured interviews and their responses were transcribed verbatim. Representative quotes about aspects of the telehealth experience were selected.