Metropolitan/nonmetropolitan differences of the impact of COVID-19 on cancer survivors' care

Purpose

To evaluate pandemic-related changes in cancer-related care for cancer survivors residing in nonmetropolitan and metropolitan areas.

Methods

We used data from the Health Information National Trends-Surveillance Epidemiology End Results (HINTS-SEER) survey administered to cancer survivors from the Greater San Francisco Bay Area, Iowa, and New Mexico between January and August 2021. Respondents were queried on changes to their cancer-related care, including treatment, follow-up appointments, and routine cancer screening/preventive care. We calculated weighted percentages and Rao-Scott chi-square tests for reported differences between nonmetropolitan and metropolitan areas.

Findings

Compared to survivors residing in metropolitan areas, a higher proportion of those in nonmetropolitan areas reported that their cancer treatment or follow-up appointments were unaffected by the pandemic (38.6% vs 28.1%; P = .008). Survivors in metropolitan areas experienced more of a shift in cancer treatment or follow-up appointments to telehealth (12.5% vs 5.7%, P = .003), but there was no difference in appointment cancellations. More survivors residing in metropolitan versus nonmetropolitan areas reported shifts to telehealth for preventive care (8.2% vs 2.9%, P = .005). There was no difference across nonmetropolitan and metropolitan survivors reporting that cancer-related care was cancelled, that routine cancer screening or preventive care was unaffected by the pandemic, or that providers discussed COVID-19 risks.

Conclusions

Survivors in nonmetropolitan compared to metropolitan areas had less perceived change in cancer follow-up and treatment schedules. It will be important to assess whether shifts in follow-up and preventive care to telehealth for cancer survivors in need of care during the COVID-19 pandemic affect their long-term outcomes.