Background The outbreak of COVID-19 pandemic in China has greatly impacted the radiotherapy (RT) strategy for breast cancer (BC) patients, which might lead to an increased distressing psychological symptom. Thus, we perform a multi-center cross-section survey aiming to investigate the prevalence of fears of cancer recurrence (FCR) and explore predictors for FCR in BC patients referred for RT during pandemic. Methods: 542 BC patients who referred for RT between 24th Jan and 30th April 2020 during pandemic were consecutively enrolled from 14 hospitals around China including Yangtze Delta River Region, Guangdong and Shanxi province. Patients’ sociodemographic, treatment information as well as psychological characteristics were collected using an information sheet, Fear of progression questionnaire-short form (FoP-Q-SF), Hospital Anxiety and Depression Scale (HADS) and EORTC QLQ-C30. The influence of pandemic on RT schedule was divided into four categories: “delay” was defined as >12 weeks from surgery to RT in patients without chemotherapy or >8 weeks from last time of anti-tumor therapy (including chemotherapy and surgery) to RT in patients with chemotherapy; “Special normal” was defined that patients themselves believed to have delayed RT initiation but actually not; “Interruption” was defined as any unplanned gaps in original RT regime and all other would be classified into “normal”. Another type of influence on RT strategy was that patients had to shift planned RT hospital from Grade-A tertiary hospital to local hospitals. Univariable analyses of FCR were performed in a one-way analysis of variance (ANOVA) or student t-test or Pearson correlation analyses and candidate variables with P<0.2 were included Hierarchical multiple regression models to investigate predictors for FCR. Guangdong province was chosen as reference in models. Results 488 patients with complete data were eligible for the present analysis and none of patients and their family members had been diagnosed as COVID-19. The RT strategy was affected in 265 (54.3%) patients, including 143 with delayed RT initiation, 66 with “special normal” schedule, 24 (4.9%) with RT interruptions, 19 shifting to local hospitals for RT, and the remaining 13 being influenced on both RT schedule and planned RT hospitals. Most of patients with affected RT strategy occurred in late January and February, when was peak of COVID-19 pandemic in China. The mean FCR scores was 24.83 (SD=8.554) and 84 patients (17.3%) were classified as dysfunctional level of FCR (sum score ≥34). In univariable analyses, FCR were significantly higher in patients who received RT in Guangdong province and in hospitals with < 100 BC cases per year. In term of during pandemic, a significant difference in FCR was observed in terms of influence on RT schedule (p<0.001). and changes of hospital levels(p=0.009). There were significant correlations between FCR and anxiety/depressive in HADS or all five function scales (physical, role, emotional, cognitive and social) and global QoL in QLQ-C30 (p<0.001). Finally, the model explained 59.7% of observed variances in FCR and showed that influence of RT strategy during pandemic had significantly impacted on FCR (ΔR2=0.01, ΔF=2.966, p=0.019). Hospitals in Shanxi province (β=-0.117, p=0.001), emotional function (β=-0.19, p<0.001), social function (β=-0.111, p=0.006), anxiety (β=0.434, p<0.001) and RT interruption (β=0.071, p=0.035) were independent predictors for FCR. Conclusions RT strategy for BC patients was greatly influenced during pandemic. RT interruption is an independent predictor for high FCR. Our findings emphasize the necessity to ensure the continuum of RT in BC patients, and efforts should be taken to alleviate the FCR through psychological interventions.

Citation Format: Jinrong Xie, Weixiang Qi, Lu Cao, Yuting Tan, Jin Huang, Xiaodong Gu, Bingguang Chen, Peipei Shen, Ying Zhang, Qingwen Zhao, Hecheng Huang, Yubin Wang, Haicheng Fang, Zhenjun Jin, Hui Li, Xuehong Zhao, Xiaofang Qian, Feifei Xu, Dan Ou, Shubei Wang, Cheng Xu, Min Li, Zefei Jiang, Yu Wang, Xiaobo Huang, Jiayi Chen. Predictors for fear of cancer recurrence in breast cancer patients referred for radiation therapy during the COVID-19 pandemic: A multi-center cross-section survey [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS2-07.