Rural cancer survivors at risk for poor outcomes, study finds

Cancer survivors who live in rural areas are more likely to say they are in poor health than those who live in urban areas, according to a study in the journal Cancer. They are also more likely to have other health disorders, more psychological distress, and be unemployed due to health reasons than city dwellers.

The study results are from a survey of 7804 cancer survivors, with about one in five from a rural area. This means there are "an estimated 2.8 million cancer survivors in rural areas of the United States," said lead author Kathryn E. Weaver, Ph.D., assistant professor at Wake Forest Baptist Medical Center in Winston-Salem, NC.

Nineteen percent of rural cancer survivors reported significant psychological distress, compared to only about 13 percent of urban cancer survivors. Weaver noted that rural survivors are more likely to have lower incomes, have less education, and lack health insurance.

"If you think of the stress of cancer and not being able to afford and access health care, I am sure that that amplifies stress for them." Unemployment or under-employment may also add stress and interfere with getting health care, since most people below retirement age in the United States get their health insurance through their employer, she added.

Another source of stress can be the greater distances a rural cancer patient or survivor must travel to see oncologists or other specialists. This lengthy travel adds to health expenses and can cause lost wages because it takes time away from work. "Cancer treatment can be involved and it requires specialty care," Weaver added.

 Previous studies have shown that rural cancer patients reported having to travel six to ten times farther for chemotherapy and two to four times farther for radiation therapy than those who live in urban areas. "I hear stories every day about patients having to travel five hours on mountain roads and not knowing how to pay for gas money," she said.

These results are not surprising to anyone who studies rural issues. "This is kind of the general story of rural health care," said Jon Bailey, J.D., director of the Rural Research and Analysis Program for the Center for Rural Affairs in Lyons, NE. "You have to make plans to see a physician or specialist. It can be an all-day trip. Even primary care physicians may be in short supply in rural areas," he noted. "For example, some counties in central and western Nebraska do not have any primary care physicians."