Obese, rural endometrial cancer survivors’ health behaviors and lifestyle intervention preferences: What's COVID-19 got to do with it? (510)

ABSTRACT

Objectives: To determine (1) if health disparities experienced by rural, obese endometrial cancer survivors (ECS) were exacerbated by the COVID-19 pandemic and (2) preferred components and delivery methods for behavioral interventions. Methods: A cross-sectional survey was distributed to obese, early- stage ECS to ascertain demographic information, physical activity (PA level), self-efficacy, lifestyle intervention preferences, as well as the impact of COVID-19 on PA, diet, and mental health. Responses were compared between obese (BMI= 30-39.9 kg/m2) and morbidly obese (BMI= 40+ kg/m2) survivors as well as those who did or did not meet national PA recommendations. Results: Among 335 eligible survivors, only 70 (20.9%) completed the survey. The median age was 63 years (IQR 14 years). Survivors were 37 months from diagnosis (IQR 37 months). The median BMI was 39.2 kg/m2 (IQR 8.4 kg/m2). Overall, only one-quarter of ECS were fairly or fully confident in their ability to undertake moderate PA. More morbidly obese survivors reported low self-efficacy in performing moderate PA than obese survivors (90% vs 65%;p= 0.02). Pre COVID-19, 66% of survivors did not meet PA guidelines and were more likely to be morbidly obese than obese, but the difference was not significant (78% vs 58%;p=0.08). Post COVID-19, 83% of survivors did not meet PA guidelines, with no difference between BMI groups (82% vs 84%;p>0.05). After COVID-19, 54% of survivors reported a decrease in PA, 32% made poorer nutritional choices, and 47% reported worsening mental health. Post COVID-19, no difference in the nutrition or mental health changes was seen between survivors who were meeting PA guidelines and those who were not (p>0.05). Regarding lifestyle interventions, survivors preferred information delivered electronically (online (56%) or via email (41%)) versus in person (30%) or via text (21%). Preferences for PA included exercising at home (46%) or online with a coach (33%) versus with a group fitness class (18%) or at the gym (17%). Combining health promotion with exercise was appealing to the majority of participants (37%), while others were not interested (27%) or unsure (31%). Responses were similar between patients meeting and not meeting PA recommendations (p>0.05). The most preferred lifestyle intervention components included tracking progress (56%), health recipes (56%), one-on-one counseling (46%), tips for cheap and healthy eating (41%), exercising alone (41%), and online sessions (39%). Conclusions: As a result of COVID-19, rural, obese ECS experienced a decrease in PA, worse nutritional decision-making, and poorer mental health. Preferred components of lifestyle interventions in this patient population were identified and can be used to develop future, evidence-based behavioral interventions. These interventions may be scalable in rural communities with limited access during the COVID-19 pandemic and beyond.