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

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The COVID-19 global pandemic has had an unprecedented impact on the lives of almost every resident of the United States. The subsequent public health mitigation strategies, including social distancing measures, are effectively reducing transmission of the COVID-19 virus, but may 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 alcohol consumption). Because rural cancer patients and rural cancer survivors already have significant barriers to accessing cancer care and engaging in healthy behaviors, the impact of COVID-19 social distancing measures may be even more pronounced in these settings. The purpose of this study is to conduct a cross-sectional survey of 800 (400 rural, 400 non-rural) cancer patients and cancer survivors to measure non-adherence to cancer care. We will also explore the degree to which COVID-19 social distancing measures are associated with non-adherence to cancer 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 15 other NCI-funded Cancer Centers (University of Alabama Coordinating Center) studying the impact of COVID-19 on health behaviors in various settings and populations. Additional items to identify cancer patients and survivors will be drawn from the literature or developed based on the Health Belief Model, informing overall survey development. We will compare proportions of cancer patients who report non-adherence to cancer care (either missed or delayed cancer treatment or surveillance) in rural and non-rural settings using the four category Rural Urban Community Access (RUCA) classification based on zip code. Our unique reach across Washington State, which includes significant Hispanic/Latino populations in rural communities, and focus exclusively on cancer patients and cancer survivors, is an essential contribution to this larger effort. The results of this study will be critical in helping understand the potentially negative health impact of COVID-19 for rural cancer patients (a particularly vulnerable group) and provide guidance to public health professionals and policy makers to develop strategies to reduce the negative health impact.