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Distance to Breast Reconstructive Services: COVID-19's Impact on Healthcare Accessibility
Valeria P. Bustos1; Stephen A. Stearns1; Anthony Haddad1; Natalie Hassell1; Samuel J. Lin1; Bernard T. Lee1
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Introduction: A multidisciplinary approach to treat patients with breast cancer is paramount to achieve optimal management, placing a large burden on this population due to frequent hospital visits. The onset of COVID-19 added an extra barrier, further impeding care to an unknown extent. Studies have found that patients undergoing breast reconstruction (BR) travel farther to access services than those forgoing BR; this is the first to examine how COVID-19 has impacted these trends in accessibility.
Methods: A retrospective study was performed on patients who underwent total mastectomy at the BIDMC. A retrospective chart review from March 2019 to August 2021 was conducted to extract sociodemographic and clinical characteristics. This study delineates two cohorts: (1)pre-COVID-19 group, and (2)COVID-19 group. Geodesic distance from the patientís address to the BIDMC was used as a measurement of access to healthcare. Measures of follow-up and breast reconstructive decisions were used to supplement the analysis. Unpaired Studentís t and Chi-Square tests were performed to assess differences between groups.
Results: A total of 211 patients were included in this study. Of those, 92 received total mastectomy in the pre-COVID-19 group and 119 in the COVID-19 group. Both cohorts had similar baseline characteristics, with an average age of 58.1 and 56.7 years, an English-speaking predominance, and a racial makeup was mainly White in 64% and 59%, respectively. When comparing the distance from the place of residence to the hospital, there was a significant difference found between the pre-COVID-19 group and the COVID-19 group (25.7 and 15.1 miles, respectively, p = 0.048), with the COVID-19 group living 12.6 miles closer on average. In our cohort before the pandemic, those electing to undergo BR travelled farther than those declining (37.1 miles versus 14.3 miles, p = 0.047). This difference was remedied during the pandemic, however (28.9 miles away and 15.7 miles away, (p = 0.13). Additionally, when tracking follow-up care, more patients during the pandemic pursued at least one follow-up visit with the BIDMC surgical team (pre-COVID: 75.0%, intra-COVID: 88.2%, p=0.016).
Conclusion: In summary, while there was no change in the rate of BR during the COVID-19 period, significant differences were seen in the pandemic cohort. Patients electing reconstruction no longer traveled farther distances for surgery than those pursuing mastectomy alone. They also sought post-operative follow-up with their original BIDMC surgical team more frequently. While the full effects of COVID-19 remain unknown, it has clearly impacted patient decision-making surrounding breast cancer care.


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