{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:14:39Z","timestamp":1758672879439,"version":"3.44.0"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":59,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005002","name":"California Department of Public Health","doi-asserted-by":"publisher","award":["1 NU58DP007156","1 NU58DP007156","1 NU58DP007156","1 NU58DP007156","1 NU58DP007156"],"award-info":[{"award-number":["1 NU58DP007156","1 NU58DP007156","1 NU58DP007156","1 NU58DP007156","1 NU58DP007156"]}],"id":[{"id":"10.13039\/100005002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["HHSN261201800002B","3P30 CA086862"],"award-info":[{"award-number":["HHSN261201800002B","3P30 CA086862"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate pandemic\u2010related changes in cancer\u2010related care for cancer survivors residing in nonmetropolitan and metropolitan areas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used data from the Health Information National Trends\u2010Surveillance Epidemiology End Results (HINTS\u2010SEER) 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\u2010related care, including treatment, follow\u2010up appointments, and routine cancer screening\/preventive care. We calculated weighted percentages and Rao\u2010Scott chi\u2010square tests for reported differences between nonmetropolitan and metropolitan areas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Compared to survivors residing in metropolitan areas, a higher proportion of those in nonmetropolitan areas reported that their cancer treatment or follow\u2010up appointments were unaffected by the pandemic (38.6%\u00a0vs 28.1%; <jats:italic>P<\/jats:italic> =\u00a0.008). Survivors in metropolitan areas experienced more of a shift in cancer treatment or follow\u2010up appointments to telehealth (12.5%\u00a0vs 5.7%, <jats:italic>P<\/jats:italic> =\u00a0.003), 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%\u00a0vs 2.9%, <jats:italic>P<\/jats:italic> =\u00a0.005). There was no difference across nonmetropolitan and metropolitan survivors reporting that cancer\u2010related care was cancelled, that routine cancer screening or preventive care was unaffected by the pandemic, or that providers discussed COVID\u201019 risks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Survivors in nonmetropolitan compared to metropolitan areas had less perceived change in cancer follow\u2010up and treatment schedules. It will be important to assess whether shifts in follow\u2010up and preventive care to telehealth for cancer survivors in need of care during the COVID\u201019 pandemic affect their long\u2010term outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.70061","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T05:38:25Z","timestamp":1753940305000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metropolitan\/nonmetropolitan differences of the impact of COVID\u201019 on cancer survivors' care"],"prefix":"10.1111","volume":"41","author":[{"given":"Whitney E.","family":"Zahnd","sequence":"first","affiliation":[{"name":"Department of Health Management and Policy College of Public Health University of Iowa  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason T.","family":"Semprini","sequence":"additional","affiliation":[{"name":"Department of Public Health College of Health Sciences Des Moines University  West Des Moines Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin C.","family":"Vanderpool","sequence":"additional","affiliation":[{"name":"Health Communication and Informatics Research Branch Behavioral Research Program Division of Cancer Control and Population Sciences National Cancer Institute  Rockville Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah H.","family":"Nash","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Iowa Cancer Registry College of Public Health University of Iowa  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin L.","family":"Van Blarigan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco  San Franscico California USA"},{"name":"Greater Bay Area Cancer Registry  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mindy C.","family":"DeRouen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco  San Franscico California USA"},{"name":"Greater Bay Area Cancer Registry  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela L. W.","family":"Meisner","sequence":"additional","affiliation":[{"name":"University of New Mexico Comprehensive Cancer Center and New Mexico Tumor Registry  Albuquerque New Mexico USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuck","family":"Wiggins","sequence":"additional","affiliation":[{"name":"University of New Mexico Comprehensive Cancer Center and New Mexico Tumor Registry  Albuquerque New Mexico USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21731"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055\u20109965.EPI\u201024\u20100072"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.6451"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27840"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/21501319241240342"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0281071"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.adf9742"},{"key":"e_1_2_8_9_1","unstructured":"ZahndWE SilvermanA SelfS et\u00a0al.The Impact of the COVID\u201019 Pandemic on Rural Health Clinics\u2019 Operations and Cancer Prevention and Control Efforts.2022."},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.2196\/34616"},{"key":"e_1_2_8_11_1","unstructured":"Health Information National Trends Survey 5 (HINTS 5): HINTS\u2010SEER Methodology Report.2022."},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2023.2290550"},{"key":"e_1_2_8_13_1","unstructured":"USDA ERS\u2014Urban Influence Codes. 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