Neuropsychiatric disorders among patients with breast cancer during the COVID-19 pandemic.

Background: A diagnosis of breast cancer can be detrimental to a patient’s neuropsychiatric health even with advancements in cancer treatment. The burden associated with a cancer diagnosis and treatment contributes to psychiatric symptoms such as anxiety, depression and other mental health concerns. The onset of the COVID-19 pandemic introduced additional challenges, including increased psychosocial stress, disruption to treatment cycles, and limited access to supportive care. While prior research has shown that concurrent viral infection can worsen neuropsychiatric symptoms in patients with breast cancer who had neuropsychiatric symptoms at the time of COVID infection, the impact of COVID-19 on the risk of neuropsychiatric diseases has been insufficiently studied. This study aims to examine the associations between COVID-19 infection and risk of poor neuropsychiatric outcomes in patients with breast cancer. Methods: Using the TriNetX Analytical Network, we identified patients diagnosed with breast cancer between April 2020 and January 2023 based on billing ICD-10 CM codes. Cohorts were created for patients with and without a positive COVID-19 test within 1 year of their breast cancer diagnosis. Cohorts were then matched using a 1:1 propensity score matching method for age, race, baseline healthcare utilization, and other potential confounding variables. Hazard ratios (HRs) for a new diagnosis of dementia, anxiety or depression were calculated using TriNetX software. Results: We identified 257, 448 breast cancer patients without a positive COVID-19 test and 26, 417 patients who had tested positive. After propensity score matching, each group had 26, 403 patients. Among patients with breast cancer who had no prior history of neuropsychiatric conditions, a COVID-19 diagnosis was associated with a higher risk of dementia, anxiety and depression (dementia HR: 1.29 (1.12, 1.48), anxiety HR: 1.23 (1.08, 1.41), depression HR: 1.13 (1.03, 1.24)). Conclusions: Patients with breast cancer who tested positive for COVID-19 had higher risks of neuropsychiatric diseases, compared to those without a COVID-19 diagnosis. The burden of having a COVID-19 infection illustrates a potential confounding factor that can contribute to increased neuropsychiatric sequelae, which healthcare providers should consider. These findings highlight the urgent need to integrate mental health support in pandemic responses as well as long term healthcare planning.