The Impact of the COVID-19 Pandemic on Cancer Care and Health-Related Quality of Life of Non-Hispanic Black/African American, Hispanic/Latina and Non-Hispanic White Women Diagnosed with Breast Cancer in the U.S.: A Mixed-Methods Study Protocol.

Chiara Acquati,Shahnjayla K. Connors,Lorna H. McNeill,Isabel Martinez Leal,Arooba A. Haq,Lorraine R. Reitzel,Stephanie Ramirez,Anastasia Rogova,Tzuan A. Chen

doi:10.3390/ijerph182413084

Abstract

The COVID-19 pandemic has had critical consequences for cancer care delivery, including altered treatment protocols and delayed services that may affect patients’ quality of life and long-term survival. Breast cancer patients from minoritized racial and ethnic groups already experience worse outcomes, which may have been exacerbated by treatment delays and social determinants of health (SDoH). This protocol details a mixed-methods study aimed at comparing cancer care disruption among a diverse sample of women (non-Hispanic White, non-Hispanic Black/African American, and Hispanic/Latina) and assessing how proximal, intermediate, and distal SDoH differentially contribute to care continuity and health-related quality of life. An embedded mixed-methods design will be implemented. Eligible participants will complete an online survey, followed by a semi-structured interview (with a subset of participants) to further understand factors that influence continuity of care, treatment decision-making, and self-reported engagement. The study will identify potentially modifiable factors to inform future models of care delivery and improve care transitions. These data will provide the necessary evidence to inform whether a subsequent, multilevel intervention is warranted to improve quality of care delivery in the COVID-19 aftermath. Additionally, results can be used to identify ways to leverage existing social resources to help manage and support patients’ outcomes.

Highlights

The present paper describes an NCI-funded mixed-methods study protocol investigating the impact the COVID-19 pandemic has on the receipt of optimal breast cancer care among a diverse sample of women
Despite growing evidence that supports adverse consequences of COVID-19 on clinical and psychosocial outcomes of cancer patients, a limited number of studies have investigated cancer care disruption and patient-reported outcomes among racial and ethnic minoritized women diagnosed with breast cancer
Given the disproportionate burden of the disease, assessing the impact of the pandemic and associated social determinants of health (SDoH) among a tri-racial and ethnic sample is critical to inform best-practices for future models of care delivery and to improve care transitions [169,170,171,172]. These data will provide the necessary evidence to inform whether a subsequent, multilevel intervention addressing these factors is warranted to improve quality of care delivery during and after the COVID-19 pandemic

Summary

Methods

Each component will be used to capture overlapping, but distinct aspects of participants’ experiences [113], i.e., quantitative data will include psychosocial outcome measures, while qualitative data will focus on capturing the context of care such as women’s personal experiences of barriers and processes in accessing care. In this embedded design, quantitative and qualitative data will be collected concurrently, in which the second qualitative strand builds on the first quantitative strand and the qualitative interview participants are selected from among the survey respondents, integrating strands on the methods level through connection via the sampling frame [114].

Results

Discussion

Conclusion