Impact of COVID-19-related psychosocial distress on health-related quality of life in rural cancer survivors
Authors: Scherezade K. Mama, Michelle Cardel, Kathryn H. Schmitz
Journal: Clinical Cancer Research (2020)

Purpose: Rural cancer survivors report poorer health-related quality of life (QOL) than those residing in urban areasand have been disproportionately impacted by COVID-19  This study explored associations between the perceivedthreat of COVID-19 and psychosocial distress due to COVID-19 on health-related QOL in rural cancer survivorsresiding in central Pennsylvania  Method: Previous participants (n=195) in the Partnering to Prevent and Control Cancer (PPCC) study who had aworking email address were sent an email invitation to complete an online questionnaire  Of the 195 cancersurvivors contacted, 90 (46 2%) have responded to the email invitation and completed the questionnaire to date The questionnaire assessed sociodemographics, perceived threat of COVID-19, psychosocial distress related toCOVID-19, and QOL (physical and social functioning, role limitations due to physical health and emotionalproblems, fatigue, emotional well-being, pain, and general health)  Linear regression models were used to exploreassociations between COVID-19 perceived threat and psychosocial distress and QOL;all models were adjusted forage, body mass index (BMI), and education  Results: Rural cancer survivors who completed the online questionnaire were mostly women (70%), non-Hispanicwhite (97 8%), in their 60s (M age=60 4±13 9 years), with overweight (M BMI=29 0±7 6 kg/m ), and collegegraduates (67 8%)  Most participants were breast (37 8%) or prostate (23 3%) cancer survivors, not currentlyreceiving treatment (93 3%), and were more than 12 weeks but less than 5 years post-treatment (93 7%)  Nearlyhalf (41 1%) of participants rated their health as excellent or very good, and 17 8% rated their health as fair or poor Generally, participants felt that COVID-19 was a threat to them, their city, school, community, or household (Mscore=17 2±3 4, scale: 5-20), but did not feel anxious, worried, or depressed due to the COVID-19 outbreak (Mscore=6 8±3 1, scale: 5-20)  Although perceived threat was not associated with QOL, psychosocial distress relatedto COVID-19 was significantly associated with role limitations due to emotional problems (B=-3 958, SE= 993, p< 001), energy/fatigue (B=-2 730, SE= 606, p< 001), emotional well-being (B=-3 733, SE= 435, p< 001), and socialfunctioning (B=-2 987, SE= 730, p< 001) in adjusted models  Conclusions: Although the perceived threat of COVID-19 was low among rural cancer survivors, participantsreported elevated psychosocial distress related to COVID-19, which negatively impacted their mental but notphysical health  These findings highlight the potential of the COVID-19 outbreak to exacerbate the persistent long-term adverse effects of cancer treatment on health-related QOL among rural cancer survivors  Psychosocial andbehavioral interventions are critically needed to reduce COVID-19-related psychosocial distress among rural cancersurvivors and to improve QOL and promote health equity among this vulnerable, underserved population