The COVID-19 pandemic put severe strain on medical care systems around the world, which in turn impacted the lives of patients, including oncological patients. A range of restrictions on social contact and travel were introduced in an attempt to minimize the spread of COVID-19. Fear of contracting the virus caused many women to postpone or cancel their medical appointments, even when they showed symptoms of a disease (Figueroa et al. 2021).

COVID-19 had a varying effect on oncological care in Poland, depending on the phase of the pandemic. The most severe changes compared to preceding years concerned the number of first-time contact and hospitalization, screening, and rehabilitation, and took place during the first wave of the pandemic (March–May 2020). Throughout this period, especially during the lockdowns, the decrease in prophylactic tests and diagnostics was particularly severe (Sęk and Cieślak 2023). In the United States, the number of mammography scans performed decreased by 89.2%, and the number of colonoscopies by 84.5% (London et al. 2020). In the UK, the number of all cancer diagnoses decreased by 18%, while the percentage of late-stage diagnoses increased (Purushotham et al. 2021). In Poland, the decrease in screening tests was significantly impacted by a notification from the president of the National Health Fund on March 15, 2020, on limiting screening tests in order to avoid the risk of spreading COVID-19 (NFZ 2020). As a result, screening tests were almost completely discontinued, especially during the first wave of the pandemic (March–May 2020), and were locally limited in the subsequent stages of screening. The decrease in screening tests, fear of infection, and numerous awareness campaigns conducted to reduce interpersonal contact were the likely causes behind the decrease in new cancer diagnoses. For example, a Spanish study found that colon cancer diagnoses decreased by almost half, primarily those performed as part of prophylactic tests (Suárez et al. 2021). Furthermore, many clinics reported a doubling of the waiting time for diagnostic procedures (Bosch et al. 2021). The present study also showed that the participants were referred to other centers or had their appointments postponed.

The authors of this study believe that the true effects of delayed diagnoses will not be understood for some time. However, there are some predictions; for example, the breast cancer mortality rate in the UK is speculated to increase from 7.9% to 9.6% over the next 5 years (Maringe et al. 2020).

The pandemic had a major impact as an additional aggravating factor on the mental health of women with breast cancer. Research conducted by other authors indicated that female patients were afraid of relapse or failing to completely cure the disease due to delayed access to medical care (Sokas et al. 2021). Other aggravating factors were the logistics of the treatment process and availability of follow-up appointments (Massicotte et al. 2021). The present study demonstrated that participants living in large and medium-sized cities were afraid of limited contact with their loved ones in the case of hospitalization. This fear was related to the restrictions imposed on visits and travel. Consequently, it must be emphasized that COVID-19 constituted an additional stressor for the participants.

It seems that the priority should be to provide oncological patients with not only medical care, but also psychological care. The results of studies conducted in Canada, the UK, and other countries show that postponed surgeries and breaks, delays, and changes in treatment procedures due to an overloaded health care system affected women with breast cancer by increasing their anxiety, depression, insomnia, fear of relapse, emotional stress, and emotional sensitivity related to the pandemic (Choobin et al. 2021; Chapman et al. 2020). Isolation meant that women with breast cancer lost access to many supportive mechanisms, including personal communication and participating in support group meetings. Researchers consider communication as key in overcoming psychological hardships, providing the necessary information, counseling, and support, and creating a safe environment for the patients (Schifferdecker et al. 2021). Professional support offered by psychologists also cannot be underestimated as a space for communication. This study revealed a statistical association between use of psychological support and place of residence. Residents of large cities use such support more often, which may be the result of its greater availability in large cities. However, this association may also result from stereotypes related to the use of psychological care and the social perception of individuals with mental disorders. Poland is one of the few countries in which studies on attitudes toward individuals with mental disorders have been conducted systematically, in several-year intervals, among representative samples of society (Wciórka 2012). Unfortunately, the results indicate that low awareness and fairly rigid stereotypes among society (with only slight differences between ages and genders) significantly affect attitudes toward individuals with mental disorders. Living in a large city makes it easier to remain anonymous, which in turn facilitates the decision to attend psychological consultations. Groups dedicated to women with cancer, including breast cancer, are viewed differently.

The use of support is determined by its availability, which includes both a patient’s family and support groups. This study revealed an association between the use of support groups and the participants’ family situation. Participants living alone joined support groups considerably more often that those living with their families. It can be assumed that individuals with families receive sufficient support, and consequently do not seek it among organized support groups. Individuals who live alone seek contact that will help them satisfy their needs.