Racial Differences in Emotional Distress Among Breast Cancer Survivors During COVID-19 Pandemic Reflects Past Healthcare Experiences

White and Black breast cancer survivors are experiencing different levels of emotional distress during the COVID-19 pandemic, a survey found, which may speak to disparities in cancer treatment that long precede the global crisis.

The COVID-19 pandemic resulted in significant delays in cancer care and treatment—but for Black patients, the delays may not be new. Previous research has found that Black women with breast cancer experience delays in diagnosis-to-treatment times. They received surgery and chemotherapy about a week after White women (average, eight days and seven days, respectively), and for radiotherapy, they waited an average three days longer than White women.

White breast cancer survivors reported significantly higher levels of distress than their Black counterparts, and according to the researchers, this may be because Black patients are already used to experiencing delays in treatment and have coping mechanisms in place for such distress.

“Prior to the pandemic, treatment delays were part of systemic and structural health inequities in the USA. The impact of these inequities had the greatest impact on Black breast cancer survivors, with significant disparities in mortality compared to White breast cancer survivors. Limited access to cancer care during the pandemic has provided a window into the risks and consequences of delays in cancer care for cancer health outcomes,” the researchers pointed out.

Two breast cancer survivors and one clinician reviewed and piloted the 50-item, electronic survey. Items pertaining to worry used a 0–100 scale, with 0 indicating disagree and 100 indicating agree. Between April 2­–27, 2020, 633 breast cancer survivors responded, including one male. Responses from 570 survivors were analyzed; 81% were White, and 19% were Black. The average age was 47.92 years (standard deviation [SD], 10.86 years), and White respondents were slightly younger (47.18 years vs. 51.16 years); the average age at diagnosis was 42.59 years (SD, 10.17 years).

More than half of respondents were currently receiving cancer treatment; 42% reported delays in care caused by the pandemic. White respondents, compared to Black ones, had higher mean all-health-related, cancer-related, and non-cancer-related distress. They were also more worried about delays/interruptions to their cancer care and their cancer care taking longer than anticipated due to COVID-19, and they were more worried that their cancer would get worse or spread during the pandemic. White respondents were also more worried about their general health and about getting COVID-19.

The study authors posed several possible explanations for these differences in levels of distress, including the pandemic itself. Black communities are experiencing higher rates of COVID-19 infection and mortality, as well as changes in factors including income, employment, and health insurance. It’s possible that Black breast cancer survivors are prioritizing other challenges during this time rather than their health and their cancer care because they are balancing other pressing items.

Although they suggested some potential reasons for the study’ results, the authors said further research is warranted, “not only to gain a systematic understanding of emotional distress related to barriers to healthcare access but also to determine how differences in emotional distress contribute to disparities in cancer health outcomes.”

The study was published in the Journal of Racial and Ethnic Health Disparities.