Purpose: Rural cancer survivors report poorer health-related quality of life (QOL) than those residing in urban areas and have been disproportionately impacted by COVID-19. This study explored associations between the perceived threat of COVID-19 and psychosocial distress due to COVID-19 on health-related QOL in rural cancer survivors residing in central Pennsylvania.

Method: Previous participants (n=195) in the Partnering to Prevent and Control Cancer (PPCC) study who had a working email address were sent an email invitation to complete an online questionnaire. Of the 195 cancer survivors 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 to COVID-19, and QOL (physical and social functioning, role limitations due to physical health and emotional problems, fatigue, emotional well-being, pain, and general health). Linear regression models were used to explore associations between COVID-19 perceived threat and psychosocial distress and QOL; all models were adjusted for age, body mass index (BMI), and education.

Results: Rural cancer survivors who completed the online questionnaire were mostly women (70%), non-Hispanic white (97.8%), in their 60s (M age=60.4±13.9 years), with overweight (M BMI=29.0±7.6 kg/m2), and college graduates (67.8%). Most participants were breast (37.8%) or prostate (23.3%) cancer survivors, not currently receiving treatment (93.3%), and were more than 12 weeks but less than 5 years post-treatment (93.7%). Nearly half (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 (M score=17.2±3.4, scale: 5-20), but did not feel anxious, worried, or depressed due to the COVID-19 outbreak (M score=6.8±3.1, scale: 5-20). Although perceived threat was not associated with QOL, psychosocial distress related to 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 social functioning (B=-2.987, SE=.730, p<.001) in adjusted models.

Conclusions: Although the perceived threat of COVID-19 was low among rural cancer survivors, participants reported elevated psychosocial distress related to COVID-19, which negatively impacted their mental but not physical 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 and behavioral interventions are critically needed to reduce COVID-19-related psychosocial distress among rural cancer survivors and to improve QOL and promote health equity among this vulnerable, underserved population.

Citation Format: Scherezade K. Mama, Michelle Cardel, Kathryn H. Schmitz. Impact of COVID-19-related psychosocial distress on health-related quality of life in rural cancer survivors [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S07-04.