OBJECTIVES: Cardiovascular care plays a crucial role in reducing the risk of adverse outcomes among breast cancer (BC) survivors. This study assesses the impact of the COVID-19 pandemic on the utilization of physician services among patients diagnosed with BC, comparing those with heart failure (HF) to those without HF.

METHODS: A difference-in-differences analysis was conducted using nationally representative de-identified claims data from the 2018-2022 Komodo Healthcare Map^TM, which included healthcare encounters from insured individuals in the United States. The datasets include information about provider visits, laboratory tests, procedures, imaging, and prescriptions. We identified individuals diagnosed with both BC and HF, and those diagnosed with BC but without HF. Physician services included primary care, oncologist, and cardiologist visits. The analysis compared the visits across three periods: pre-pandemic, early pandemic, and late pandemic. We estimated model parameters using finite mixture negative binomial hurdle models to calculate adjusted odds ratios (aORs) and rate ratios (aRRs) for each of the three visit categories. The interaction effects of HF and the pandemic indicators on visits were estimated.

RESULTS: We identified 11,819 individuals diagnosed with both BC and HF (mean age of 69.4 years), while 118,487 individuals were diagnosed with BC and no HF (mean age of 60.5 years). Compared to individuals with comorbid HF in the pre-pandemic period, comorbid HF in the early pandemic was associated with lower odds of a cardiologist visit (aOR 0.84 [0.79-0.89]). Findings were similar when comparing the late pandemic period to the pre-pandemic period for the cardiologist visits (aOR 0.70 [0.66-0.74]). The RRs were unchanged over time for all outcomes except oncologist visits (aRR for early vs pre-pandemic: 1.12 [1.03-2.21]).

CONCLUSIONS: Among individuals diagnosed with BC and HF, we found potential crowding out of cardiologist services. Additional research is needed to better understand the impact of the pandemic on individuals diagnosed with BC.