How Did Breast Cancer Patients Fare during Different Phases of the COVID-19 Pandemic in Norway Compared to Age-Matched Controls?
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Cases and Controls
2.2. The CRN HRQoL Survey
2.3. Study Sample According to COVID-19 Phases
- Phase 1—“lockdown” (September 2020–September 2021): Phase 1 was characterized by extended periods of lockdown or social restrictions until Norway officially reopened on 25 September 2021 [24]. The mammographic screening program was not closed during this period, but some places may have operated at a slower pace. Number of responders during phase 1: n = 1818 cases and 1690 controls.
- Phase 2—“high infection rates” (October 2021–February 2022): Phase 2 was characterized by few social restrictions, but the Omicron variant resulted in a peak in COVID-19 infections in Norway [25]. Number of responders during phase 2: n = 886 cases and 318 controls.
- Phase 3—“post-pandemic” (March 2022–December 2022): Phase 3 was characterized by “back to normal” as Norway ceased testing and monitoring of new COVID-19 cases [24]. Number of responders during phase 3: n = 1585 cases and 903 controls.
2.4. Statistical Analysis
3. Results
3.1. HRQoL across COVID-19 Phases
3.2. COVID19-Related Factors
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Case (N = 4279) | Control (N = 2911) | p |
---|---|---|---|
Age, mean (SD) | 58.0 (11.4) | 59.1 (11.2) | <0.01 |
BMI, mean (SD) | 26.1 (5.1) | 25.8 (4.8) | 0.01 |
Residing in capital area, n (%) | 747 (25.7) | 1097 (25.6) | |
Relationship status, n (%) | 0.99 | ||
In a relationship | 3288 (76.8) | 2232 (76.7) | |
Not in a relationship | 847 (19.4) | 575 (19.8) | |
Missing | 144 (3.4) | 104 (3.6) | |
Children <18 living at home, n (%) | <0.01 | ||
No | 3153 (73.7) | 2248 (77.2) | |
Yes | 993 (23.2) | 568 (19.5) | |
Missing | 133 (3.1) | 95 (3.3) | |
Employed, n (%) | <0.01 | ||
No | 637 (14.9) | 516 (17.7) | |
Yes | 2507 (58.6) | 1710 (58.7) | |
No, retired | 936 (21.9) | 542 (18.6) | |
Missing | 199 (4.7) | 143 (4.9) | |
Educational level, n (%) | 0.03 | ||
Primary school | 305 (7.1) | 238 (8.2) | |
Secondary school | 1503 (35.1) | 1037 (35.6) | |
College/university ≤ 4 years | 1255 (29.3) | 890 (30.6) | |
College/university > 4 years | 1079 (25.2) | 655 (22.5) | |
Missing | 137 (3.2) | 91 (3.1) | |
Exercise levels, n (%) | <0.01 | ||
No exercise. Physically active ≤ 3 h/w | 564 (13.2) | 323 (11.1) | |
No exercise. Physically active > 3 h/w | 1423 (33.3) | 796 (27.3) | |
Exercise 0–1 h/w | 1044 (24.4) | 764 (26.2) | |
Exercise 2–3 h/w | 815 (19.0) | 677 (23.3) | |
Exercise 4+ h/w | 279 (6.5) | 253 (8.7) | |
Missing | 154 (3.6) | 98 (3.4) | |
Smoking, n (%) | <0.01 | ||
Never smoker | 1930 (45.1) | 1366 (46.9) | |
Former smoker | 1809 (42.3) | 1114 (38.3) | |
Current smoker | 408 (9.5) | 334 (11.5) | |
Missing | 132 (3.1) | 97 (3.3) | |
Alcohol consumption, n (%) | <0.01 | ||
No | 1166 (27.2) | 683 (23.5) | |
Yes | 2977 (69.6) | 2133 (73.3) | |
Missing | 136 (3.2) | 95 (3.3) | |
BMI group (kg/m2), n (%) | 0.19 | ||
<25 | 1779 (41.6) | 1260 (43.3) | |
25–29 | 1454 (34.0) | 974 (33.5) | |
≥30 | 865 (20.2) | 545 (18.7) | |
Missing | 181 (4.2) | 132 (4.5) |
Medical Data | Total N = 4279 | Phase 1 “Lockdown” N = 1818 | Phase 2 “High Infection Rate” N = 886 | Phase 3 “Post-Pandemic” N = 1575 |
---|---|---|---|---|
Age, mean (SD) | 58.0 (11.4) | 57.7 (11.4) | 58.3 (11.1) | 58.2 (11.6) |
Stage, n (%) | ||||
I | 1815 (42.4) | 766 (42.1) | 420 (47.4) | 629 (39.9) |
II | 1069 (25.0) | 462 (25.4) | 195 (22.0) | 412 (26.2) |
III | 312 (7.3) | 134 (7.4) | 60 (6.8) | 118 (7.5) |
IV | 84 (2.0) | 40 (2.2) | 15 (1.7) | 29 (1.8) |
Unknown | 999 (23.3) | 416 (22.9) | 196 (22.1) | 387 (24.6) |
HER2 status, n (%) | ||||
Negative | 3226 (75.4) | 1354 (74.5) | 691 (78.0) | 1181 (75.0) |
Positive | 442 (10.3) | 194 (10.7) | 79 (8.9) | 169 (10.7) |
Unknown | 611 (14.3) | 270 (14.9) | 116 (13.1) | 225 (14.3) |
ER status, n (%) | ||||
Negative | 480 (11.2) | 198 (10.9) | 98 (11.1) | 184 (11.7) |
Positive | 3242 (75.8) | 1372 (75.5) | 681 (76.9) | 1189 (75.5) |
Unknown | 557 (13.0) | 248 (13.6) | 107 (12.1) | 202 (12.8) |
PR status, n (%) | ||||
Negative | 1063 (24.8) | 446 (24.5) | 209 (23.6) | 408 (25.9) |
Positive | 2606 (60.9) | 1101 (60.6) | 561 (63.3) | 944 (59.9) |
Unknown | 610 (14.3) | 271 (14.9) | 116 (13.1) | 223 (14.2) |
Treatment status at survey response, n (%) | ||||
Responded prior to surgery | 1240 (29.0) | 482 (26.5) | 244 (27.5) | 514 (32.6) |
BCT | 2396 (56.0) | 1033 (56.8) | 500 (56.4) | 863 (54.8) |
BCT + radiation therapy | 226 (5.3) | 130 (7.2) | 52 (5.9) | 44 (2.8) |
Mastectomy | 400 (9.3) | 163 (9.0) | 88 (9.9) | 149 (9.5) |
Mastectomy + radiation therapy | 7 (0.2) | 7 (0.4) | 0 | 0 |
Radiation therapy, surgery unknown | 10 (0.2) | 3 (0.2) | 2 (0.2) | 5 (0.3) |
Time from diagnosis to response, n (%) | ||||
≤1 month | 1938 (45.3) | 797 (43.8) | 370 (41.8) | 771 (49.0) |
2–3 months | 2106 (49.2) | 897 (49.3) | 469 (52.9) | 740 (47.0) |
4–6 months | 65 (1.5) | 29 (1.6) | 21 (2.4) | 15 (1.0) |
>6 months | 8 (0.2) | 4 (0.2) | 2 (0.2) | 2 (0.1) |
Unknown | 162 (3.8) | 91 (5.0) | 24 (2.7) | 47 (3.0) |
Phase 1 “Lockdown” | Phase 2 “High Infection Rate” | Phase 3 “Post-Pandemic” | |||||||
---|---|---|---|---|---|---|---|---|---|
Variables | Case (N = 1818) | Control (N = 1690) | p | Case (N = 886) | Control (N = 318) | p | Case (N = 1575) | Control (N = 903) | p |
Age, mean (SD) | 57.7 (11.4) | 58.9 (11.0) | <0.01 | 58.3 (11.1) | 59.6 (11.0) | 0.07 | 58.2 (11.6) | 59.4 (11.8) | 0.02 |
BMI, mean (SD) | 26.3 (5.2) | 25.7 (4.8) | <0.01 | 26.0 (4.9) | 25.5 (4.5) | 0.11 | 25.9 (5.0) | 25.9 (4.8) | 0.97 |
Relationship status, n (%) | 0.70 | 0.43 | 0.86 | ||||||
In a cohabitating relationship | 1290 (71.0) | 1184 (70.1) | 611 (69.0) | 222 (69.8) | 1137 (72.2) | 657 (72.8) | |||
In a relationship, but not living together | 105 (5.8) | 97 (5.7) | 58 (6.5) | 24 (7.5) | 87 (5.5) | 48 (5.3) | |||
Not in a relationship | 353 (19.4) | 348 (20.6) | 174 (19.6) | 52 (16.4) | 320 (20.3) | 175 (19.4) | |||
Missing | 70 (3.9) | 61 (3.6) | 43 (4.9) | 20 (6.3) | 31 (2.0) | 23 (2.5) | |||
Children <18 living at home, n (%) | 0.00 | 0.84 | 0.02 | ||||||
No | 1311 (72.1) | 1302 (77.0) | 652 (73.6) | 231 (72.6) | 1190 (75.6) | 715 (79.2) | |||
Yes | 436 (24.0) | 326 (19.3) | 194 (21.9) | 71 (22.3) | 363 (23.0) | 171 (18.9) | |||
Missing | 71 (3.9) | 62 (3.7) | 40 (4.5) | 16 (5.0) | 22 (1.4) | 17 (1.9) | |||
Educational level, n (%) | 0.40 | 0.06 | 0.29 | ||||||
Primary school | 127 (7.0) | 124 (7.3) | 56 (6.3) | 32 (10.1) | 122 (7.7) | 82 (9.1) | |||
Secondary school | 649 (35.7) | 610 (36.1) | 314 (35.4) | 102 (32.1) | 540 (34.3) | 325 (36.0) | |||
College/university ≤ 4 years | 519 (28.5) | 512 (30.3) | 244 (27.5) | 98 (30.8) | 492 (31.2) | 280 (31.0) | |||
College/university > 4 years | 454 (25.0) | 384 (22.7) | 230 (26.0) | 71 (22.3) | 395 (25.1) | 200 (22.1) | |||
Missing | 69 (3.8) | 60 (3.6) | 42 (4.7) | 15 (4.7) | 26 (1.7) | 16 (1.8) | |||
Employed, n (%) | 0.00 | 0.26 | 0.36 | ||||||
No | 349 (19.2) | 381 (22.5) | 105 (11.9) | 27 (8.5) | 183 (11.6) | 108 (12.0) | |||
Yes | 1047 (57.6) | 1007 (59.6) | 516 (58.2) | 188 (59.1) | 944 (59.9) | 515 (57.0) | |||
No, retired | 302 (16.6) | 199 (11.8) | 219 (24.7) | 84 (26.4) | 415 (26.3) | 259 (28.7) | |||
Missing | 120 (6.6) | 103 (6.1) | 46 (5.2) | 19 (6.0) | 33 (2.1) | 21 (2.3) | |||
Exercise levels, n (%) | 0.00 | 0.00 | 0.00 | ||||||
No exercise Physically active ≤ 3 h/w | 214 (11.8) | 197 (11.7) | 135 (15.2) | 30 (9.4) | 215 (13.7) | 96 (10.6) | |||
No exercise Physically active > 3 h/w | 622 (34.2) | 472 (27.9) | 278 (31.4) | 81 (25.5) | 523 (33.2) | 243 (26.9) | |||
Exercise 0–1 h/w | 424 (23.3) | 442 (26.2) | 220 (24.8) | 91 (28.6) | 400 (25.4) | 231 (25.6) | |||
Exercise 2–3 h/w | 344 (18.9) | 383 (22.7) | 149 (16.8) | 72 (22.6) | 322 (20.4) | 222 (24.6) | |||
Exercise 4+ h/w | 141 (7.8) | 133 (7.9) | 53 (6.0) | 28 (8.8) | 85 (5.4) | 92 (10.2) | |||
Missing | 73 (4.0) | 63 (3.7) | 51 (5.8) | 16 (5.0) | 30 (1.9) | 19 (2.1) | |||
Smoking, n (%) | 0.00 | 0.56 | 0.01 | ||||||
Never smoker | 850 (46.8) | 779 (46.1) | 388 (43.8) | 148 (46.5) | 692 (43.9) | 439 (48.6) | |||
Former smoker | 748 (41.1) | 643 (38.0) | 352 (39.7) | 122 (38.4) | 709 (45.0) | 349 (38.6) | |||
Current smoker | 153 (8.4) | 201 (11.9) | 105 (11.9) | 32 (10.1) | 150 (9.5) | 101 (11.2) | |||
Missing | 67 (3.7) | 67 (4.0) | 41 (4.6) | 16 (5.0) | 24 (1.5) | 14 (1.6) | |||
Alcohol consumption, n (%) | 0.01 | 0.63 | 0.00 | ||||||
No | 495 (27.2) | 400 (23.7) | 230 (26.0) | 78 (24.5) | 441 (28.0) | 205 (22.7) | |||
Yes | 1253 (68.9) | 1230 (72.8) | 616 (69.5) | 225 (70.8) | 1108 (70.3) | 678 (75.1) | |||
Missing | 70 (3.9) | 60 (3.6) | 40 (4.5) | 15 (4.7) | 26 (1.7) | 20 (2.2) | |||
BMI group (kg/m2), n (%) | 0.04 | 0.25 | 0.69 | ||||||
<25 | 740 (40.7) | 742 (43.9) | 348 (39.3) | 137 (43.1) | 691 (43.9) | 381 (42.2) | |||
25–29 | 591 (32.5) | 558 (33.0) | 316 (35.7) | 108 (34.0) | 547 (34.7) | 308 (34.1) | |||
≥30 | 396 (21.8) | 315 (18.6) | 173 (19.5) | 50 (15.7) | 296 (18.8) | 180 (19.9) | |||
Missing | 91 (5.0) | 75 (4.4) | 49 (5.5) | 23 (7.2) | 41 (2.6) | 34 (3.8) |
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Svendsen, K.; Leithe, S.; Trewin-Nybråten, C.B.; Balto, A.; Nes, L.S.; Meland, A.; Børøsund, E.; Kiserud, C.E.; Reinertsen, K.V.; Eriksen, H.R.; et al. How Did Breast Cancer Patients Fare during Different Phases of the COVID-19 Pandemic in Norway Compared to Age-Matched Controls? Cancers 2024, 16, 602. https://doi.org/10.3390/cancers16030602
Svendsen K, Leithe S, Trewin-Nybråten CB, Balto A, Nes LS, Meland A, Børøsund E, Kiserud CE, Reinertsen KV, Eriksen HR, et al. How Did Breast Cancer Patients Fare during Different Phases of the COVID-19 Pandemic in Norway Compared to Age-Matched Controls? Cancers. 2024; 16(3):602. https://doi.org/10.3390/cancers16030602
Chicago/Turabian StyleSvendsen, Karianne, Sigrid Leithe, Cassia B. Trewin-Nybråten, Aina Balto, Lise Solberg Nes, Anders Meland, Elin Børøsund, Cecilie E. Kiserud, Kristin Valborg Reinertsen, Hege R. Eriksen, and et al. 2024. "How Did Breast Cancer Patients Fare during Different Phases of the COVID-19 Pandemic in Norway Compared to Age-Matched Controls?" Cancers 16, no. 3: 602. https://doi.org/10.3390/cancers16030602
APA StyleSvendsen, K., Leithe, S., Trewin-Nybråten, C. B., Balto, A., Nes, L. S., Meland, A., Børøsund, E., Kiserud, C. E., Reinertsen, K. V., Eriksen, H. R., Gjelsvik, Y. M., & Ursin, G. (2024). How Did Breast Cancer Patients Fare during Different Phases of the COVID-19 Pandemic in Norway Compared to Age-Matched Controls? Cancers, 16(3), 602. https://doi.org/10.3390/cancers16030602