Patterns of care and treatment delays among patients with early-stage breast cancer: long term impact of the COVID-19 (C19) pandemic

Purpose: To assess the long-term impact of the COVID-19 (C19) pandemic, we examined treatment patterns and delays in early-stage breast cancer (BC). Methods: Patients ≥ 18 years with clinical stage I–III BC diagnosed between 2019 and 2022 were identified in the National Cancer Database. Patients were categorized as pre-C19 (2019), early-C19 (2020), late-C19 (2021), and post-C19 (2022). Descriptive statistics assessed changes in early-stage BC treatment patterns and time-to-treatment initiation. Multivariable logistic regression was used to identify factors associated with treatment delays > 60 days. Results: A decline in BC cases was observed during the pre- to early-C19 period, it was more pronounced among patients with stage I disease. While surgery as initial treatment decreased from pre- to post-C19, chemotherapy use increased. The early-C19 period was associated with lower odds of any treatment initiation delays > 60 days (adjusted odds ratio [aOR] = 0.87; 95% CI 0.85–0.89) while late-C19 (aOR = 1.20; 95% CI 1.17–1.22) and post-C19 (aOR = 1.46; 95% CI 1.43–1.49) were associated with higher odds compared to pre-C19. Black (aOR = 1.59; 95% CI 1.55–1.63) and Hispanic (aOR = 1.57; 95% CI 1.53–1.61) patients were more likely to have any treatment initiation delays. Conclusions: The C19 pandemic disrupted BC care, contributing to ongoing treatment delays. Future studies are needed to understand how systemic factors impact long-term outcomes.