COVID-19, breast cancer care, and social determinants of health: a cross-sectional study

The aims of this study were to explore the impact of COVID-19 on healthcare services and quality of life (QoL) in women living with and beyond BC in Ireland and whether the impact varied by social determinants of health (SDH). The survey study invited women diagnosed with BC to complete a questionnaire measuring the impact of COVID-19, disruption to BC services, QoL, SDH, and clinical covariates during a period of COVID-19 restrictions. The association between COVID-19 impact, disruption to BC services, and QoL was assessed using multivariable regression with adjustment for SDH and clinical covariates. An interaction between COVID-19 impact and health insurance status was assessed within each multivariable regression model. In total, 387 women completed the survey and 30.5% reported a high COVID-19 impact. Women who reported a high COVID-19 impact had significantly more disruption in BC services(OR = 4.54, CI = 2.15, 9.61, p < 0.001) and a lower QoL(β = -12.4, SE 3.31, p < 0.001) compared to women who reported a low COVID-19 impact. Finally, women with a high COVID-19 impact and no insurance experienced significantly more disruption to BC services(OR = 2.53, CI = 1.30, 4.92, p = 0.006) and lower QoL(β = -18.6, SE = 3.92, p < 0.001). There was a large disruption to BC services and decrease in QoL for women with BC in Ireland during the pandemic. However, the impact of COVID-19 was not the same for all women. It is important that women with BC are reintegrated back into BC care and their QoL is addressed through multidisciplinary support services. KEY MESSAGES: • Health systems must learn from the pandemic to improve services and to avoid detrimental impact of future disasters. • Health insurance status is a key determinant for women with breast cancer in Ireland.