Breast Cancer Survivorship Care During the COVID-19 Pandemic Within an Urban New York Hospital System

PURPOSE/OBJECTIVE(S): The COVID-19 pandemic has placed a tremendous burden on healthcare systems and has forced oncology providers and cancer patients to balance pandemic risks with maintaining standard cancer survivorship care. We evaluated adherence to long-term follow-up among early-stage breast cancer patients in an urban, academic cancer center in the New York City borough of The Bronx during the COVID-19 pandemic. MATERIALS/METHODS: We retrospectively reviewed patients with stage I-II breast cancer who underwent resection and adjuvant therapy at our center. Adherence with long-term follow-up was evaluated based on contact with any oncology specialist (surgical, medical, or radiation) at our center between two and five years after breast cancer surgery. Patients were deemed adherent to follow-up during COVID-19 if they attended an oncology follow-up appointment (in-person or telemedicine) between March 1 and December 1, 2020; patients were deemed non-adherent if they attended follow-up during the same date range in 2019, prior to the pandemic, but did not follow-up during the COVID-19 period. Adherence during COVID-19 was compared with pre-COVID rates of follow-up. Clinical and demographic data were evaluated as potential predictors of adherence. Local COVID-19 case rates were estimated from public data by ZIP code during the peak of the pandemic in April 2020. Multivariate logistic regression was performed to identify associations with follow-up non-adherence. RESULTS: During COVID-19, 496 (68%) of 734 patients were adherent to follow-up. Of the adherent group, 40.5% had telemedicine visits. The rate of follow-up adherence during COVID-19 was dramatically lower than historic adherence rates of 89-96%, which varied depending on time since resection. On multivariate analysis, adherence was more likely among patients who had received adjuvant radiation therapy (adjusted Odds Ratio [aOR] 1.4; P = 0.032) and smokers (aOR 1.6; P = 0.041). When patients who live in The Bronx were stratified by ZIP code, there was no association (R(2) = 0.01) between local COVID-19 case rates and likelihood of adherence during the COVID-19 pandemic. CONCLUSION: To our knowledge, this is the first analysis evaluating the potential effect of COVID-19 on cancer survivorship care. We observed a dramatic disruption in long-term follow-up during the COVID-19 period, despite prevalent utilization of telemedicine visits. Overall, if the observed rate of non-adherence persists and patients are not reintegrated into regular follow-up patterns after the COVID-19 period, it has the potential to dramatically affect cancer survival outcomes.