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Abstract：
BACKGROUND: The indirect impact of the coronavirus disease 2019 pandemic on healthcare services was studied by assessing changes in the trend of the time to first treatment for women 18 or older who were diagnosed and treated for breast cancer between 2017 and 2021.
METHODS: An observational retrospective longitudinal study based on aggregated data from four European Union (EU) countries/regions investigating the time it took to receive breast cancer treatment. We compiled outputs from a federated analysis to detect structural breakpoints, confirming the empirical breakpoints by differences between the trends observed and forecasted after March 2020. Finally, we built several segmented regressions to explore the association of contextual factors with the observed changes in treatment delays.
RESULTS: We observed empirical structural breakpoints on the monthly median time to surgery trend in Aragon (ranging from 9.20 to 17.38 days), Marche (from 37.17 to 42.04 days) and Wales (from 28.67 to 35.08 days). On the contrary, no empirical structural breakpoints were observed in Belgium (ranging from 21.25 to 23.95 days) after the pandemic\'s beginning. Furthermore, we confirmed statistically significant differences between the observed trend and the forecasts for Aragon and Wales. Finally, we found the interaction between the region and the pandemic\'s start (before/after March 2020) significantly associated with the trend of delayed breast cancer treatment at the population level.
CONCLUSIONS: Although they were not clinically relevant, only Aragon and Wales showed significant differences with expected delays after March 2020. However, experiences differed between countries/regions, pointing to structural factors other than the pandemic.
METHODS: An observational retrospective longitudinal study based on aggregated data from four European Union (EU) countries/regions investigating the time it took to receive breast cancer treatment. We compiled outputs from a federated analysis to detect structural breakpoints, confirming the empirical breakpoints by differences between the trends observed and forecasted after March 2020. Finally, we built several segmented regressions to explore the association of contextual factors with the observed changes in treatment delays.
RESULTS: We observed empirical structural breakpoints on the monthly median time to surgery trend in Aragon (ranging from 9.20 to 17.38 days), Marche (from 37.17 to 42.04 days) and Wales (from 28.67 to 35.08 days). On the contrary, no empirical structural breakpoints were observed in Belgium (ranging from 21.25 to 23.95 days) after the pandemic\'s beginning. Furthermore, we confirmed statistically significant differences between the observed trend and the forecasts for Aragon and Wales. Finally, we found the interaction between the region and the pandemic\'s start (before/after March 2020) significantly associated with the trend of delayed breast cancer treatment at the population level.
CONCLUSIONS: Although they were not clinically relevant, only Aragon and Wales showed significant differences with expected delays after March 2020. However, experiences differed between countries/regions, pointing to structural factors other than the pandemic.
摘要：
背景：通过评估2017年至2021年间诊断和治疗乳腺癌的18岁或18岁以上女性首次治疗时间的趋势，研究了2019年冠状病毒病大流行对医疗保健服务的间接影响。
方法：一项观察性回顾性纵向研究，基于来自四个欧盟（EU）国家/地区的汇总数据，调查了接受乳腺癌治疗所需的时间。我们编译了联邦分析的输出来检测结构断点，通过2020年3月后观察到的和预测的趋势之间的差异来确认经验断点。最后,我们构建了几个分段回归,以探索情境因素与观察到的治疗延迟变化之间的关联.
结果：我们观察到阿拉贡每月中位手术时间趋势的经验结构断点（范围为9.20至17.38天），Marche（从37.17天到42.04天）和威尔士（从28.67天到35.08天）。相反,大流行开始后，比利时没有观察到经验结构断点（范围为21.25至23.95天）。此外，我们证实了阿拉贡和威尔士的观察趋势与预测之间的统计学差异。最后,我们发现,该地区与大流行开始(2020年3月之前/之后)之间的相互作用与人群层面的乳腺癌治疗延迟趋势显著相关.
结论：尽管它们没有临床相关性，只有阿拉贡和威尔士与2020年3月后的预期延误表现出显著差异。然而,国家/地区之间的经验不同，指出了大流行以外的结构性因素。
方法：一项观察性回顾性纵向研究，基于来自四个欧盟（EU）国家/地区的汇总数据，调查了接受乳腺癌治疗所需的时间。我们编译了联邦分析的输出来检测结构断点，通过2020年3月后观察到的和预测的趋势之间的差异来确认经验断点。最后,我们构建了几个分段回归,以探索情境因素与观察到的治疗延迟变化之间的关联.
结果：我们观察到阿拉贡每月中位手术时间趋势的经验结构断点（范围为9.20至17.38天），Marche（从37.17天到42.04天）和威尔士（从28.67天到35.08天）。相反,大流行开始后，比利时没有观察到经验结构断点（范围为21.25至23.95天）。此外，我们证实了阿拉贡和威尔士的观察趋势与预测之间的统计学差异。最后,我们发现,该地区与大流行开始(2020年3月之前/之后)之间的相互作用与人群层面的乳腺癌治疗延迟趋势显著相关.
结论：尽管它们没有临床相关性，只有阿拉贡和威尔士与2020年3月后的预期延误表现出显著差异。然而,国家/地区之间的经验不同，指出了大流行以外的结构性因素。
