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The COVID-19 pandemic and its effects on follow-up of patients with early breast cancer: A patient survey

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Abstract

Purpose

Despite limited evidence supporting its effectiveness, most guidelines recommend long-term, routinely scheduled in-person surveillance of patients with early breast cancer (EBC). The COVID-19 pandemic led to increased use of virtual care. This survey evaluated patient perspectives on follow-up care.

Methods

Patients with EBC undergoing surveillance were surveyed about follow-up protocols, perceptions, and interest in clinical trials assessing different follow-up strategies.

Results

Of 402 approached patients 270 completed the survey (response rate 67%). Median age 62.5 years (range 25–86) and median time since breast cancer diagnosis was 3.8 years (range < 1–33 years). Most (n = 148/244, 60%) were followed by more than one provider. Routine follow-ups with breast examination were mostly conducted by medical/radiation oncologists every 6 months (n = 110/236, 46%) or annually (n = 106/236, 44%). Participants felt routine follow-up was useful to monitor for recurrence, manage side effects of cancer treatment and to provide support/reassurance. Most participants felt regular follow-up care would detect recurrent cancer earlier (n = 214/255, 96%) and increase survival (n = 218/249, 88%). The COVID-19 pandemic reduced the number of in-person visits for 54% of patients (n = 63/117). Patients were concerned this reduction of in-person visits would lead to later detection of both local (n = 29/63, 46%) and distant recurrences (n = 25/63, 40%). While many felt their medical and radiation oncologists were the most suited to provide follow-up care, 55% felt comfortable having their primary care provider (PCP) conduct surveillance. When presented with a scenario where follow-up has no effect on earlier detection or survival, 70% of patients still wanted routine in-person follow-up for reassurance (63%) with the goal of earlier recurrence detection (56%).

Conclusions

Despite limited evidence of effectiveness of routine in-person assessment, patients continue to place importance on regularly scheduled in-person follow-up.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on request with approval of the Ontario Cancer Research Ethics Board.

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Acknowledgements

We would like to acknowledge OH-CCO Integrated Cancer Program Funding Agreement as a person-centered funding line item and Jill Taylor and Beth Ciavaglia as our patient representatives.

Funding

This research was supported by the Ottawa Hospital and Cancer Care Ontario’s Integrated Cancer Program initiative which funds patient-centred research as well as the Rethinking Clinical Trials (REaCT) program at the Ottawa Hospital, which is supported by The Ottawa Hospital Foundation and its donors.

Author information

Authors and Affiliations

  1. Division of Medical Oncology, Department of Medicine, The University of Ottawa, Ottawa, ON, Canada

    Ana-Alicia Beltran-Bless, Parvaneh Fallah, Terry Ng, Nasser Alqahtani, John Hilton & Mark Clemons

  2. The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada

    Gail Larocque, Angel Arnaout, Jean-Michel Caudrelier, Denise Boone, Terry Ng, John Hilton & Mark Clemons

  3. Department of Surgery, London Health Sciences Centre, London, ON, Canada

    Muriel Brackstone

  4. Department of Surgery, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada

    Angel Arnaout

  5. Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada

    Jean-Michel Caudrelier & Peter Cross

  6. Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Terry Ng, John Hilton, Lisa Vandermeer & Mark Clemons

  7. Department of Oncology, McMaster University, Hamilton, ON, Canada

    Gregory Pond

Authors
  1. Ana-Alicia Beltran-Bless
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Contributions

AB, GL, AA, JC, JH, NA, LV, GP, and MC designed the survey and prepared the protocol. LV collected the data and coordinated the study. GP did the statistical analysis. AB wrote the manuscript. All authors had full access to the data and took responsibility for the integrity of the data and accuracy of the data analysis. All authors were involved in the critical review of the manuscript and approved the final version.

Corresponding author

Correspondence to Mark Clemons.

Ethics declarations

Conflict of interest

No competing interests to declare.

Ethical approval

This study was approved by the Ontario Cancer Research Ethics Board (OCREB).

Consent to participate

Participation and completion of the survey implied consent to participate.

Consent for publication

Participation and completion of the survey implied consent to publication of aggregate survey findings.

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Supplementary Material 1: Ongoing treatment related side effects

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Beltran-Bless, AA., Larocque, G., Brackstone, M. et al. The COVID-19 pandemic and its effects on follow-up of patients with early breast cancer: A patient survey. Breast Cancer Res Treat 204, 531–538 (2024). https://doi.org/10.1007/s10549-023-07232-3

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  • DOI: https://doi.org/10.1007/s10549-023-07232-3

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