Impact of COVID-19 on breast cancer patients and services in a UK region: Protocol for a mixed methods study

Abstract

Background Globally, breast cancer screening, diagnosis and treatment services were significantly impacted by the COVID-19 pandemic. Locally, the Northern Ireland Cancer Registry (NICR) reported an 11% reduction in breast cancers diagnosed April-December 2020 compared with the same period 2018−2019 despite an expected increase. This study aims to identify how the patient journey was impacted by the COVID-19 pandemic and how service provision can be improved. Methods Population-based quantitative data will be collected by NICR for individuals diagnosed with invasive breast cancer (ICD 10 code C50). Data on presentation, investigations, comorbidities (including COVID-19 infection), molecular markers, stage at diagnosis, treatment, and survival will be examined. Two time periods will be compared: March-December 2018 (pre-COVID-19 cohort) and March-December 2020 (COVID-19 cohort). Analysis will include descriptive statistics, chi-square tests and ANOVAs. Patient experiences of living with breast cancer and interacting with the healthcare system during the pandemic (March 2020-April 2024) will be captured through an online, self-completed, anonymous cross-sectional international survey. Quality of life will be captured in the survey using the EQ-5D-3L. Detailed descriptive qualitative interviews will be undertaken to better understand the lived experience of breast cancer and recommend ways that services and support programs can effectively meet the needs of this patient group. This study benefits from the inclusion of patient representatives who have been involved since the inception of this project. Discussion This study aims to quantify the impact of the COVID-19 pandemic on breast cancer patient outcomes in a UK region and make recommendations to improve patient care and outcomes in the short and long term.