Measuring the Impact of the COVID-19 Pandemic on Health Behaviors and Health Care Utilization in Rural and Urban Patients with Cancer and Cancer Survivors

Health care access and health behaviors differ between those living in urban and rural communities and contribute to inequitable cancer health outcomes. The COVID-19 pandemic led to significant disruptions in daily life and health care delivery. This cross-sectional survey aimed to measure the impact of the COVID-19 pandemic on the health behaviors of patients with cancer and survivors, comparing outcomes for urban and rural respondents. Survey was administered from January 2021 to June 2021 to patients with cancer or survivors (treated within the last 5 years) at one of six cancer centers in Washington and Idaho. Respondent ZIP code was used to assess rurality using rural-urban commuting area designation. A total of 515 rural (43.5% of those contacted) and 146 urban (40% of those contacted) patients with cancer and survivors participated. Few differences between urban and rural patients with cancer and cancer survivors were noted. Rural residents were older (69.2 vs. 66.9 years). Rural respondents had higher mean alcohol consumption than urban respondents (4.4 vs. 2.7 drinks per week). A total of 12.2% of those who reported drinking in the last 30 days also reported increased alcohol consumption since the start of the pandemic, with no difference in reported increased alcohol consumption in rural versus urban respondents. A total of 38.5% reported decreased physical activity. A total of 20.5% reported canceling or delaying cancer care due to the COVID-19 pandemic. Delays in cancer health care services and worsening health behaviors due to the COVID-19 pandemic may contribute to poorer health outcomes, with few differences between rural and urban patients with cancer and cancer survivors. SIGNIFICANCE: COVID19 led to significant disruptions in health care access and daily life. Rural communities experience barriers to healthy behaviors and health care access that contribute to poorer cancer outcomes, compared with urban populations. The impact of COVID19 on rural and urban patients with cancer and cancer survivors has not been assessed.