The Impact of COVID-19 and Social Distancing on Cancer-Related Behaviors

Given the wide variability in communication and restrictions across communities in the U.S. in response to the COVID-19pandemic, the extent to which people across the country are changing their behaviors to mitigate risk of transmission isunknown. Furthermore, it is difficult to anticipate how changing behaviors in response to COVID-19 could impact cancerrelated behaviors and risk factors; exercising, drinking, smoking, diet and stress could be profoundly impacted as a resultof social distancing and self-isolation. Furthermore, different populations may be impacted in very different ways. Forexample, Iowa is among the handful of predominantly rural states that have not yet implemented a statewide shelter inplace order, citing lower risk of infection in rural areas. Yet in this first week of April, the case rate in rural areas hasmore than doubled from one week prior, and widespread testing is not available to assess the true extent of the casecount. It has also been reported that in rural areas without reliable internet access, adults are struggling to workremotely, and children are having to get school assignments delivered to their door.1 Furthermore, rural communitiesmay have diminished access to health information, healthcare services, grocery stores and pharmacies.As a multicenter group of cancer researchers already invested deeply in understanding and improving health outcomesin our catchment areas, we propose to rapidly deploy surveys containing a standard set of core questions to populationsacross the U.S. The overall objective of our collaborative effort is to assess how differences in demographics (rurality,age, gender, race, educational attainment) will impact engagement in cancer preventive behaviors (e.g., tobaccocessation) and cancer management/survivorship behaviors (e.g., adherence to treatment, adherence to surveillance) inthe context of COVID-19 environmental constraints (e.g., social distancing, employment, mental health, etc.) among thegeneral adult populations, cancer patients, and cancer survivors in Iowa.