PURPOSE: COVID-19 has altered healthcare delivery . Previous work has focused on patients with cancer and COVID-19, but little has been reported on healthcare system changes among patients without COVID-19 .
METHODS: We performed a retrospective study of patients with breast cancer (BC) in New York City between February 1 , 2020, and April 30 , 2020 . New patients were included as were patients scheduled to receive intravenous or injectable therapy . Patients with COVID-19 were excluded . Demographic and treatment information were obtained by chart review . Delays and/or changes in systemic therapy, surgery, radiation, and radiology related to the pandemic were tracked, along with the reasons for delay and/or change . Univariate and multivariable analysis were used to identify factors associated with delay and/or change .
RESULTS: We identified 350 eligible patients, of whom 149 (42.6 %) experienced a delay and/or change, and practice reduction (51.0 %) was the most common reason . The patients who identified as Black or African American, Asian, or Other races were more likely to experience a delay and/or change compared with White patients (Black , 44.4% ; Asian , 47.1% ; Other , 55.6% ; White , 31.4% ; P = .001). In multivariable analysis, Medicaid compared with commercial insurance (odds ratio [OR], 3.04; 95% CI , 1.32 to 7.27) was associated with increased odds of a delay and/or change, whereas stage II or III BC compared with stage I (OR , 0.38; 95% CI , 0.15 to 0.95; and OR , 0.28; 95% CI , 0.08 to 0.092, respectively) was associated with decreased odds of a delay and/or change .
CONCLUSION: Almost half of the patients with BC without COVID-19 had a delay and/or change . We found racial and socioeconomic disparities in the likelihood of a delay and/or change . Further studies are needed to determine the impact these care alterations have on BC outcomes.