title: The health and welfare of rural and urban cancer survivors in Missouri.
abstract: BACKGROUND
  An estimated 2.8 million cancer survivors reside in rural areas in the United States. We compared the risk behaviors, psychosocial factors, health outcomes, quality of life, and follow-up care of rural and urban cancer survivors in Missouri.
  
  
  METHODS
  We used 2009-2010 Missouri Behavioral Risk Factor Surveillance System data to examine various health outcomes, behaviors, and psychosocial factors among rural and urban cancer survivors and their respective rural and urban counterparts without a cancer history. Cancer survivors also were asked about receipt of survivorship care plan components. Sociodemographic factors, access to medical care, and chronic conditions were examined as potential explanatory factors for differences among the 4 groups.
  
  
  RESULTS
  An estimated 9.4% of rural and 7.9% of urban Missourians aged 18 years or older reported a cancer history. Rural survivors reported the highest rates of poor self-reported health, physical distress, and activity limitation; however differences between rural and urban survivors were attributable largely to sociodemographic differences. Both rural and urban cancer survivors reported more fatigue than their respective counterparts without a cancer history. Rural survivors also were less likely to meet Centers for Disease Control and Prevention recommendations for physical activity than their rural controls. The prevalence of smoking among rural survivors was higher than among urban survivors. Only 62% of rural survivors versus 78% of urban survivors reported receiving advice about cancer follow-up care.
  
  
  CONCLUSIONS
  Rural cancer survivors face many health challenges. Interventions to improve quality of life and health behaviors should be adapted to meet the needs of rural cancer survivors.
authors.affiliation: Washington University School of Medicine, Department of Medicine, Division of Health Behavior Research, 4444 Forest Park Ave, Saint Louis, MO 63108, USA. mschootm@dom.wustl.edu
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
authors.forename: Sherri
authors.initials: S
authors.lastname: Homan
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Weaver
authors.forename: Donna B
authors.initials: DB
authors.lastname: Jeffe
authors.forename: Shumei
authors.initials: S
authors.lastname: Yun
mesh_terms: D000293:Adolescent; D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D005260:Female; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D008019:Life Style; D008297:Male; D008923:Missouri / Q000453:epidemiology; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D017741:Survivors / Q000706:statistics & numerical data*; D014505:Urban Population; D055815:Young Adult
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