Differences in supportive care service utilization among long term metastatic breast cancer survivors by rurality.

Abstract

12093 Background: Patients living with metastatic breast cancer (MBC) have unique psychosocial and medical needs, which often go unrecognized. Many patients living in rural areas travel farther for care. We examined differences in supportive care service referrals and utilization by sociodemographic, psychosocial, and clinical predictors among long term MBC survivors living in rural versus urban areas. Methods: 233 patients from the Ohio State University Stefanie Spielman Comprehensive Breast Center, who had been diagnosed with MBC for ≥1 year, were asked to complete a one-time, online survey to assess their demographic characteristics, quality of life, self-rated health, symptoms, and supportive care needs. Chi-square and fisher exact tests were used for categorical variables and two sample t-tests were used for continuous variables to determine sociodemographic (age, race, education, income, rural/urban residency), psychosocial/quality of life (PROMIS physical component score, PROMIS mental component score, MOS social support), and clinical factors (time since diagnosis, current treatment, metastasis site, fatigue, pain, and sleep) associated with utilization of supportive care services. Results: 66 patients residing in rural areas (RURAL) and 167 patients residing in urban areas (URBAN) were recruited. There was a higher rate of supportive care service utilization among URBAN (n=82, 49.1%) versus RURAL (n=22, 33.3%) patients. For URBAN, service utilization was associated with lower (worse) PROMIS physical scores, PROMIS mental scores, MOS social support total scores, and greater fatigue and pain scores. However, no significant associations were seen for RURAL. Higher education and income levels were associated with increased service utilization for RURAL, but not URBAN participants. The Table details referral and utilization rates for the top 5 supportive care services. Conclusions: Patients living in rural areas had lower supportive care utilization compared to patients living in urban areas. However, urban patients reported worse PROMIS and social support scores. While a no cost service (dietitian) had similar utilization rates between URBAN and RURAL, another (James Care for Life programs) did not. Services amenable to same day coordination had no statistical differences in utilization rates between URBAN and RURAL. More research is needed to evaluate the impact of distance, financial, and time barriers on equitable access to supportive care services. Top 5 supportive care referrals and utilization. Rural Urban Referred Utilized Referred Utilized Counseling 8 (12.1%) 4 (50%) 34 (20.4%) 20 (58.8%) Dietitian 11 (16.7%) 8 (72.7%) 35 (21%) 27 (77.1%) James Care for Life Programs 8 (12.1%) 3 (37.5%) 27 (16.2%) 15 (75%) Living Well with Advanced Breast Cancer Clinic 14 (21.2%) 2 (14.3%) 20 (12%) 15 (75%) Physical Therapy 7 (10.6%) 6 (85.7%) 36 (21.6%) 29 (75%)