Impact of COVID-19 on patients with metastatic breast cancer: REthink Access to Care and Treatment survey results

Figures & data

Table 1. Participant self-reported demographics.

Demographic characteristics			Participants, n (%)^† (N = 341)
Race, n (%)
American Indian or Alaska Native			7 (2.1)
Asian			15 (4.4)
Black or African–American			15 (4.4)
Native Hawaiian or other Pacific Islander			2 (0.6)
White			307 (90.0)
Other			4 (1.2)
Participant-reported education level, n (%)
Did not complete high school			1 (0.3)
High school graduate or equivalent or attended some high school			16 (4.7)
Associates degree, or attended some college			77 (22.6)
College graduate			143 (41.9)
Completed graduate school or attended some graduate school			104 (30.5)
Stage of breast cancer at initial diagnosis, n (%)^†
Stage 0			13 (3.8)
Stage I			34 (10.0)
Stage II			107 (31.4)
Stage III			54 (15.8)
Stage IV			133 (39.0)
Not sure/I don't remember			0.0
Comorbidities, self reported, n (%)^‡
Congestive heart failure			2 (0.6)
Heart disease			11 (3.2)
Lung disease			24 (7.0)
Diabetes			29 (8.5)
Kidney disease			7 (2.1)
Liver disease			3 (0.9)
Immunocompromised/immunosuppressed			25 (7.3)
Obesity			58 (17.0)
Smoker			12 (3.5)
Other			71 (20.8)
None			176 (51.6)
Receptor status, n (%)^‡
Receptor	Positive	Negative	Don't Know
ER	249 (73.0)	93 (27.3)	3 (0.9)
PR	206 (60.4)	121 (35.5)	18 (5.3)
HER2	124 (36.4)	209 (61.3)	10 (2.9)

† All participants were stage IV at time of survey.

‡ Results may total >100% as participants were allowed to select ≥1 choice.

Figure 1. Changes in scheduled visits and effects on patient experience.

(A) Participant-reported changes in scheduled visits due to the pandemic, and (B) effects of changes in scheduled clinical visits on patient experience (n = 178)*^†.

*185 participants reported a change to a scheduled clinical visit due to the pandemic, 7 of these participants reported an unspecified change, with no data collected about the type of change or the experience and thus were excluded from this cohort.

^†Results may total >100% because participants could select ≥1 choice.

Figure 2. Effects of COVID-19 on laboratory tests and diagnostic imaging appointments.

Participants reported changes, delays and/or cancelations of laboratory tests and diagnostic imaging appointments that occurred during the COVID-19 pandemic, and how they were affected by this. (A) COVID-19 pandemic effects on laboratory and diagnostic imaging appointments* (n = 341). (B) Participant experience of changed laboratory and diagnostic imaging appointments* (n = 341).

*Results may total >100% because participants could select ≥1 choice.

Figure 3. Level of difficulty of using of online services.

Participants (n = 341) rated how difficult (not at all – very much) they found using different types of online services during the COVID-19 pandemic. Participants who did not use online services could select ‘didn't use’.

Table 2. COVID-19 effects on treatment.

Treatment, n (%) N = 341^†	Route of administration changed from iv. or injected to oral	Medication(s) changed	Delayed one or more doses of treatment	Stopped or paused treatment	Treatment location changed	Other	Not affected
Chemotherapy	3 (0.9)	3 (0.9)	32 (9.4)	3 (0.9)	10 (2.9)	4 (1.2)	296 (86.8)
Hormone therapy	1 (0.3)	2 (0.6)	10 (2.9)	5 (1.5)	1 (0.3)	0	329 (96.5)
Immunotherapy	1 (0.3)	1 (0.3)	7 (2.1)	1 (0.3)	2 (0.6)	0	331 (97.1)
Targeted therapy	2 (0.6)	2 (0.6)	30 (8.8)	5 (1.5)	4 (1.2)	4 (1.2)	301 (88.3)
Radiation therapy for a tumor	NA	NA	13 (3.8)^‡	1 (0.3)	4 (1.2)	3 (0.9)	321 (94.1)
Radiation therapy for pain	NA	NA	2 (0.6)^‡	0	4 (1.2)	2 (0.6)	333 (97.7)

† Results may total >100% because participants could select ≥1 choice.

‡ Delayed one or more treatment sessions.

iv.: Intravenous; NA: Not applicable.

Table 3. Patient experience of treatment changes due to COVID-19.

Changed treatment, n (%) N = 341^†	Much improved	A little improved	About the same	A little worse	Much worse	Not affected
Chemotherapy	0	1 (0.3)	8 (2.3)	34 (10.0)	2 (0.6)	296 (86.8)
Hormone therapy	0	1 (0.3)	1 (0.3)	9 (2.6)	1 (0.3)	329 (96.5)
Immunotherapy	0	0	0	9 (2.6)	1 (0.3)	331 (97.1)
Targeted therapy	1 (0.3)	1 (0.3)	8 (2.3)	28 (8.2)	2 (0.6)	301 (88.3)
Radiation therapy for a tumor	0	0	3 (0.9)	13 (3.8)	4 (1.2)	321 (94.1)
Radiation therapy for pain	0	1 (0.3)	0	4 (1.2)	3 (0.9)	333 (97.7)

† Results may total >100% because participants could select ≥1 choice.

Table 4. Patient experience of expanded opportunities due to telemedicine and relaxed regulations^†.

Patient treatment opportunities	Participants, n (%) N = 341^‡
Consulted healthcare providers in a different state	43 (12.6)
Consulted healthcare providers in-state but outside of my normal geographic range	32 (9.4)
Enrolled in a trial in a different state	5 (1.5)
Enrolled in a trial in-state but outside my normal geographic range	4 (1.2)
Did not access healthcare providers outside my state/geographic range	272 (79.8)

† Temporary recognition of medical licensure across state lines.

‡ Results may total >100% because participants could select ≥1 choice.

Figure 4. Effects of COVID-19 pandemic on daily living activities.

Participants (n = 341) selected daily activities that had changed during the COVID-19 pandemic (11 daily activities were presented for selection within the survey). Participants also rated how the change in daily activities had changed their well-being (much improved – much worse).

*Participants who were not presented with a given question, due to the operation of skip logic based on their previous answers, are included in the data as ‘Not presented’.

Table 5. Effects of COVID-19 on participant employment.

Employment effect^†	Participants, n (%) N = 341	Participants reporting employment effects, n (%) n = 81
Worked fewer hours	41 (12.0)	41 (50.6)
Worked more hours	7 (2.1)	7 (8.6)
Transitioned to working from home	33 (9.7)	33 (40.7)
Was laid off temporarily (furloughed)	15 (4.4)	15 (18.5)
Was let go from my job	7 (2.1)	7 (8.6)
Had to change arrangements for childcare or schooling	18 (5.3)	18 (22.2)
canceled or delayed time off	9 (2.6)	9 (11.1)
Other	12 (3.5)	12 (14.8)

† Results may total >100%, as participants were allowed to select ≥1 choice.

Table 6. Patient support changes during COVID-19.

Type of support, n (%) N = 341	Much improved	A little improved	About the same	A little worse	Much worse	Not affected
Support with transportation	6 (1.8)	1 (0.3)	10 (2.9)	42 (12.3)	4 (1.2)	278 (81.5)
Support with daily needs (e.g., preparing meals, bathing, grooming, dressing, maintaining my home, paying bills)	5 (1.5)	12 (3.5)	19 (5.6)	59 (17.3)	4 (1.2)	242 (71.0)
Support with errands (e.g., getting groceries, picking up medications)	6 (1.8)	6 (1.8)	13 (3.8)	80 (23.5)	7 (2.1)	229 (67.2)
Emotional support	9 (2.6)	21 (6.2)	4 (1.2)	37 (10.9)	13 (3.8)	257 (75.4)
Support in coordinating cancer care or managing medical problem	4 (1.2)	5 (1.5)	2 (0.6)	72 (21.1)	4 (1.2)	254 (74.5)

Figure 5. Clinical trial experience of participants with progression.

Participants who had MBC disease progression reported on their experience, if any, of clinical trials during the COVID-19 pandemic (n = 164)*.

*Results may total >100% because participants could select ≥1 choice.

MBC: Metastatic breast cancer.