Long-Term Adverse Outcomes Among Rural Cancer Survivors in a Population-Based Cohort

摘要 美国农村人口在癌症筛查、癌症治疗和生存方面存在差异， 癌症患者与城市人口相比。癌症幸存者可能会经历由癌症引起的晚期效应。 癌症治疗，如心脏毒性和随后的心血管疾病（CVD）。率较高 肥胖和吸烟，健康保险覆盖率较低，农村地区获得初级保健的机会减少 农村人口的增加可能导致农村癌症幸存者中慢性病发病率较高。更高 癌症幸存者和农村人口中阿片类药物的使用率令人担忧，但很少有研究 在农村癌症幸存者身上。基于人口的农村癌症幸存者队列将包括农村 1997年至2015年诊断的前列腺癌、乳腺癌和结直肠癌患者。该队列将被开发 与犹他州SEER癌症登记处合作，该登记处的数据与犹他州人口数据库（CQB）相关联， 包括电子医疗记录、全州医疗机构数据、居住史、家族史 所有付款人索赔数据库（APCD）。我们还将在2010年为相同的癌症建立队列， SEER-Medicare数据侧重于老年人群，包括数据中除 犹他州。本研究的具体目的是：1）评估农村居民糖尿病、心血管疾病和抑郁症的患病风险 乳腺癌、前列腺癌和结直肠癌患者与其各自的城市癌症患者组相比， 一个基于人口的群体。我们将进一步研究癌症治疗是否会导致不良反应。 农村癌症幸存者的结果。2)为了评估农村乳腺癌患者中阿片类药物使用障碍的风险， 前列腺癌和结直肠癌患者与城市癌症患者的比较以及阿片类药物 使用生存期疾病，3）估计癌症诊断后随时间推移的合并症轨迹，以及 农村乳腺癌、前列腺癌和结肠直肠癌患者主要身体系统疾病的风险， 与各自的城市癌症患者群体进行比较。目标3将允许捕获潜在的新 这些结果可能对农村癌症幸存者更为重要。我们的研究在评估 农村癌症幸存者的长期疾病发病率风险首次采用纵向方法， 在犹他州的一个大规模人群队列和美国的老年人中。我国农村人口 癌症幸存者队列将通过确定具体的癌症治疗方案， 在农村癌症幸存者中预防疾病和改善 生存我们还将确定潜在的可改变因素，这些因素可以针对农村癌症幸存者， 提供远程医疗和戒烟护理等干预措施。未来的发展方向包括 开发专门针对农村癌症幸存者的风险预测模型，这将有助于识别农村 高风险的癌症幸存者将受益于特定的预防干预措施。

Abstract Rural populations in the US experience disparities in cancer screening, cancer treatment, and survival for cancer patients compared to urban populations. Cancer survivors may experience late effects caused by the cancer treatment such as cardiotoxicity and subsequent cardiovascular disease (CVD). The higher rates of obesity and smoking, lower health insurance coverage rates, and decreased access to primary care in rural populations may contribute to higher incidence rates of chronic diseases among rural cancer survivors. Higher rates of opioid use among cancer survivors and among rural populations are a concern, but few studies are available on rural cancer survivors. The Population-Based Rural Cancer Survivors Cohort will include rural prostate, breast and colorectal cancer patients diagnosed from 1997 to 2015. The cohort will be developed with the Utah SEER Cancer Registry, which has data linked to the Utah Population Database (UPDB), and includes electronic medical records, statewide healthcare facility data, residential histories, family history records, and the All-Payer Claims Database (APCD). We will also develop cohorts for the same cancers in the SEER-Medicare data focusing on the elderly population including all SEER registries in the data other than Utah. The specific aims of our study are: 1) to assess the risk of diabetes, CVD and depression among rural breast, prostate and colorectal cancer patients in comparison to their respective urban cancer patient groups in a population-based cohort. We will further investigate whether cancer treatments contribute to adverse outcomes among rural cancer survivors. 2) to evaluate the risk of opioid use disorders among rural breast, prostate and colorectal cancer patients in comparison to urban cancer patients and the association of opioid use disorders with survival, 3) to estimate the comorbidity trajectory over time after cancer diagnosis, as well as risks of diseases in the major body systems among rural breast, prostate and colorectal cancer patients in comparison to their respective urban cancer patient groups. Aim 3 will allow for capture of potential new outcomes that may be more important among rural cancer survivors. Our study is innovative in assessing the risk of long-term disease incidence among rural cancer survivors for the first time, with a longitudinal approach, in a large-scale population-based cohort in Utah and in the elderly in the US. Our Population-Based Rural Cancer Survivors Cohort will contribute significantly to rural cancer survivorship by identifying specific outcomes that are more common among rural cancer survivors for prevention of disease and improved survival. We will also identify potential modifiable factors that can be targeted for rural cancer survivors with interventions such as access to care with telemedicine and tobacco cessation. Future directions include the development of risk prediction modeling specifically for rural cancer survivors, that would help to identify rural cancer survivors at high risk who would benefit from specific preventive interventions.