Background:
Health services for non-communicable diseases, including cancer, were significantly disrupted during COVID-19. Breast cancer (BC) is the most common cancer for women and the on-going impact of the pandemic on BC care needs to be established. The aims of this study were to explore the impact of COVID-19 stressors on healthcare services and quality of life (QoL) in women living with and beyond BC in Ireland and whether the impact varied by social determinants of health (SDH).

Methods:
This cross-sectional study was conducted from September 2020 to April 2021. Questionnaire data was collected on predictor variables (e.g. COVID-19 impact, SDH, and clinical characteristics) and outcome variables (e.g. disrupted health services and QoL). The association between COVID-19 impact, disruption to BC services, and QoL was assessed using multivariable regression models. The interaction between COVID-19 impact and health insurance status was assessed within each model.

Results:
Of the 387 women who completed the survey, 30.5% reported a high COVID-19 impact and most women reported disrupted BC care. Women who reported a high COVID-19 impact reported significantly more disrupted BC services (p<0.001) and a lower QoL (p<0.001) compared to women who reported a low COVID-19 impact. Private health insurance was found to significantly moderate the impact of COVID-19 on BC services and QoL. Women with a high COVID-19 impact and no insurance experienced significantly more disruption to BC services and lower QoL compared to women with low COVID-19 impact and private insurance (p<0.05).

Conclusions:
There was a large disruption to BC services and low QoL for women with BC in Ireland, however, the impact of COVID-19 was not the same for all women. It is important to identify the women who experienced a larger impact during the pandemic so they can be reintegrated into proper BC care, along the entire cancer continuum.