Long-Term Adverse Outcomes Among Rural Cancer Survivors in a Population-Based Cohort

Abstract
Rural populations in the US experience disparities in cancer screening, cancer treatment, and survival for
cancer patients compared to urban populations. Cancer survivors may experience late effects caused by the
cancer treatment such as cardiotoxicity and subsequent cardiovascular disease (CVD). The higher rates of
obesity and smoking, lower health insurance coverage rates, and decreased access to primary care in rural
populations may contribute to higher incidence rates of chronic diseases among rural cancer survivors. Higher
rates of opioid use among cancer survivors and among rural populations are a concern, but few studies are
available on rural cancer survivors. The Population-Based Rural Cancer Survivors Cohort will include rural
prostate, breast and colorectal cancer patients diagnosed from 1997 to 2015. The cohort will be developed
with the Utah SEER Cancer Registry, which has data linked to the Utah Population Database (UPDB), and
includes electronic medical records, statewide healthcare facility data, residential histories, family history
records, and the All-Payer Claims Database (APCD). We will also develop cohorts for the same cancers in the
SEER-Medicare data focusing on the elderly population including all SEER registries in the data other than
Utah. The specific aims of our study are: 1) to assess the risk of diabetes, CVD and depression among rural
breast, prostate and colorectal cancer patients in comparison to their respective urban cancer patient groups in
a population-based cohort. We will further investigate whether cancer treatments contribute to adverse
outcomes among rural cancer survivors. 2) to evaluate the risk of opioid use disorders among rural breast,
prostate and colorectal cancer patients in comparison to urban cancer patients and the association of opioid
use disorders with survival, 3) to estimate the comorbidity trajectory over time after cancer diagnosis, as well
as risks of diseases in the major body systems among rural breast, prostate and colorectal cancer patients in
comparison to their respective urban cancer patient groups. Aim 3 will allow for capture of potential new
outcomes that may be more important among rural cancer survivors. Our study is innovative in assessing the
risk of long-term disease incidence among rural cancer survivors for the first time, with a longitudinal approach,
in a large-scale population-based cohort in Utah and in the elderly in the US. Our Population-Based Rural
Cancer Survivors Cohort will contribute significantly to rural cancer survivorship by identifying specific
outcomes that are more common among rural cancer survivors for prevention of disease and improved
survival. We will also identify potential modifiable factors that can be targeted for rural cancer survivors with
interventions such as access to care with telemedicine and tobacco cessation. Future directions include the
development of risk prediction modeling specifically for rural cancer survivors, that would help to identify rural
cancer survivors at high risk who would benefit from specific preventive interventions.

Grant Number: 5R01CA244326-05
NIH Institute/Center: NIH
Principal Investigator: NICOLA CAMP