CCSG Supplement: Impact of COVID-19 on Cancer-related Health Behaviors in Rural Cancer Patients and Cancer Survivors.

The COVID-19 global pandemic has had an unprecedented impact on the lives of almost everyresident of the United States. The subsequent public health mitigation strategies, includingsocial distancing measures, are effectively reducing transmission of the COVID-19 virus, butmay have negative impact on behaviors important for cancer patients and cancer survivors (e.g.adhering to cancer treatment or cancer surveillance, physical activity, healthy diet, or alcoholconsumption). Because rural cancer patients and rural cancer survivors already have significantbarriers to accessing cancer care and engaging in healthy behaviors, the impact of COVID-19social distancing measures may be even more pronounced in these settings. The purpose ofthis study is to conduct a cross-sectional survey of 800 (400 rural, 400 non-rural) cancerpatients and cancer survivors to measure non-adherence to cancer care. We will also explorethe degree to which COVID-19 social distancing measures are associated with non-adherence tocancer care and unhealthy cancer-related health behaviors for rural and non-rural participants.Survey items will be drawn from core items developed by a collaboration with more than 15other NCI-funded Cancer Centers (University of Alabama Coordinating Center) studying theimpact of COVID-19 on health behaviors in various settings and populations. Additional itemsto identify cancer patients and survivors will be drawn from the literature or developed basedon the Health Belief Model, informing overall survey development. We will compareproportions of cancer patients who report non-adherence to cancer care (either missed ordelayed cancer treatment or surveillance) in rural and non-rural settings using the four categoryRural Urban Community Access (RUCA) classification based on zip code. Our unique reachacross Washington State, which includes significant Hispanic/Latino populations in ruralcommunities, and focus exclusively on cancer patients and cancer survivors, is an essentialcontribution to this larger effort. The results of this study will be critical in helping understandthe potentially negative health impact of COVID-19 for rural cancer patients (a particularlyvulnerable group) and provide guidance to public health professionals and policy makers todevelop strategies to reduce the negative health impact.