Psychosocial outcomes and care utilization among rural and nonrural cancer patients.

Abstract

79 Background: Approximately 20% of people diagnosed with cancer in the U.S. travel from rural areas to urban cancer centers for treatment. Rural cancer patients face unique challenges which may contribute to greater psychosocial distress when compared to urban-dwelling patients. While up to half of all cancer patients screen positive for psychosocial distress, only 25-44% of distressed patients utilize psychosocial care. Patients from rural areas may face greater barriers to utilization of psychosocial care compared to patients from urban areas. To date, few studies have focused on these concerns. Methods: Three-years of data were collected from newly diagnosed patients screened between 2015 and 2017, including the Patient Health Questionnaire-2 and the NCCN Distress Thermometer (n = 4,865). Adjusted multi-variable logistic regression, chi-square, and negative binomial regression were used to assess relationships among psychosocial outcomes and care utilization, rurality, and distance to treatment in driving miles, controlling for socio-demographic and clinical covariates. Distance to treatment based on driving miles computed in ArcGIS v10.5. Stata v15 was used for all statistical analyses, significance set at ≤.05. Results: Higher odds of depressive symptoms were detected among people living in rural areas compared to urban areas. The odds of psychosocial distress were higher in patients from rural areas and further distances from treatment compared to local distance. Patients from rural areas had lower odds of psychosocial care utilization compared to patients in urban areas. Distance to treatment had independent effects, over and above rurality, for lower odds of psychosocial care utilization. Conclusions: Distance to treatment and rurality appear to be risk factors with independent effects on depressive symptoms and psychosocial distress and appear to be associated with lower odds of psychosocial care use among cancer patients with self-reported distress when compared to patients from urban and local areas. Findings support improved detection of and response to patient reported psychosocial outcomes, and further research designed to better understand the mechanisms underlying the reported associations.