title: Cancer Survivorship in Rural and Urban Adults: A Descriptive and Mixed Methods Study.
abstract: OBJECTIVE
  Rural-dwelling cancer survivors (CSs) are at risk for decrements in health and well-being due to decreased access to health care and support resources. This study compares the impact of cancer in rural- and urban-dwelling adult CSs living in 2 regions of the Pacific Northwest.
  
  
  METHODS
  A convenience sample of posttreatment adult CSs (N = 132) completed the Impact of Cancer version 2 (IOCv2) and the Memorial Symptom Assessment Scale-short form. High and low scorers on the IOCv2 participated in an in-depth interview (n = 19).
  
  
  RESULTS
  The sample was predominantly middle-aged (mean age 58) and female (84%). Mean time since treatment completion was 6.7 years. Cancer diagnoses represented included breast (56%), gynecologic (9%), lymphoma (8%), head and neck (6%), and colorectal (5%). Comparisons across geographic regions show statistically significant differences in body concerns, worry, negative impact, and employment concerns. Rural-urban differences from interview data include access to health care, care coordination, connecting/community, thinking about death and dying, public/private journey, and advocacy.
  
  
  CONCLUSIONS
  The insights into the differences and similarities between rural and urban CSs challenge the prevalent assumptions about rural-dwelling CSs and their risk for negative outcomes. A common theme across the study findings was community. Access to health care may not be the driver of the survivorship experience. Findings can influence health care providers and survivorship program development, building on the strengths of both rural and urban living and the engagement of the survivorship community.
authors.affiliation: Arizona State University, College of Nursing and Health Innovation, Phoenix, Arizona.
authors.forename: Julie A
authors.initials: JA
authors.lastname: McNulty
authors.affiliation: Oregon Health and Science University, School of Nursing, Portland, Oregon.
authors.forename: Lillian
authors.initials: L
authors.lastname: Nail
mesh_terms: D000328:Adult; D055812:Community-Based Participatory Research; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: cancer survivorship; impact of cancer; late effects; rural health; rural-urban cancer survivorship