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

## TL;DR

The study found that cancer survivors in nonmetropolitan areas experienced less disruption in care during the pandemic compared to those in metropolitan areas.

## Contribution

The paper highlights geographic disparities in how the pandemic affected cancer care access and delivery.

## Key findings

- Nonmetropolitan survivors reported less disruption in cancer treatment and follow-up appointments.
- Metropolitan survivors were more likely to shift to telehealth for treatment and preventive care.
- There was no significant difference in appointment cancellations between the two areas.

## Abstract

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

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.

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.

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.