Disparities in mental health between rural and nonrural cancer survivors: a preliminary study

Abstract

Objective-While much research has sought to identify disparities in cancer incidence, survival, and treatment, little research has sought to identify disparities in mental health outcomes among cancer survivors. The present study aimed to identify disparities in mental health outcomes between rural and nonrural cancer survivors.Methods-Cancer survivors who met eligibility criteria were identified through the Kentucky SEER Cancer Registry. Rural status was determined by 2003 USDA Rural-Urban Continuum Codes. 116 (n = 54 rural, 62 nonrural) survivors with diagnoses of breast (n=42), hematologic (n=39) or colorectal (n=35) cancer completed mail-back questionnaires and/or a telephone interview.Results-Rural cancer survivors reported poorer mental health functioning (Effect size; ES = .45 SD), greater symptoms of anxiety (ES = .70) and depression (ES = .47), greater distress (ES = . 41), and more emotional problems (ES = .47) than nonrural cancer survivors. Rural and nonrural cancer survivors did not differ consistently in regard to positive mental health outcomes, such as benefit finding. The pattern of results was maintained when adjusted for education and physical functioning.Conclusions-Clinically important disparities in mental health outcomes were evident between rural and nonrural cancer survivors. Interventions aimed at raising access and utilization of mental health services may be indicated for cancer survivors in rural areas. Keywordscancer; oncology; healthcare disparities; mental health; rural health Cancer disparity research has focused primarily on identifying population-based characteristics linked to cancer incidence, survival, and treatment [1][2][3][4]. While the mental health (MH) of cancer survivors is of great significance [5][6], little research has examined the link between population-based characteristics and MH outcomes among cancer survivors. In particular, there is scant research examining whether geographic residence, that is whether an individual resides in a rural or nonrural area, has significant bearing on an individual's MH following cancer diagnosis. Since over 10 million cancer survivors live in the United States (U.S.) [7], and roughly 20% of the population resides in rural areas, one can estimate the presence of approximately 2 million rural cancer survivors. With such a large number of rural cancer survivors, it is important to consider whether rural residence might be an important predictor of MH in cancer survivors. There are several reasons to believe residing in a rural area, characterized by low population density and geographic isolation [8][9], might influence adjustment after cancer diagnosis. First, disparate rates of comorbidity [9] and variation in cancer treatment received by rural and nonrural residents [10][11], may place rural cancer survivors at risk for poor physical functioning, which might have negative implications for MH. Second, few MH professionals (e.g., psychologists, psychiatrists), long travel distances to healthcare providers, low rates of ins...

Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review

“…There were 11 quantitative studies with a control group [15][16][17][18][19][20][21][22][23][24][25]. Three addressed emotional issues, one travel issues and the remainder the general needs and quality of life of cancer survivors.…”

“…One US study of 116 heterogenous cancer patients [17] compared rates of emotional morbidity between urban and rural cancer patients; rural patients reported significantly poorer mental health functioning (effect size -ES= 0.45), higher levels of anxiety (ES=0.70) and depression (ES=0.47), greater distress (ES+0.41) and more emotional problems (ES=0.47) than nonrural cancer survivors. There was no difference between groups for positive mental health outcomes such as benefit finding.…”

“…While the number of more rigorous, population-based studies with an urban control group has increased in the past few years, most have measured unmet needs or quality of life, with only one study addressing psychological morbidity [17]. More research is needed for different cancer types and addressing psychosocial morbidity.…”

Supportive care needs of rural individuals living with cancer: A literature review

“…These are examples of challenges that disproportionately affect rural cancer patients and have the potential to lead to severe emotional and psychological distress. In one study, Burris and Andrykowski (2010) compared the mental health outcomes of rural and non-rural cancer survivors. The rural participants reported higher rates of anxiety, depressive symptoms, overall distress, and poorer mental health functioning and life satisfaction when compared to urban participants.…”

Prioritizing Mental Health Research in Cancer Patients and Survivors

“…Among long-term cancer survivors, depression and anxiety are the most commonly diagnosed psychological disorders [7]. However, mental health care disparities exist between rural and urban cancer survivors with respect to transportation, practitioner availability, and insurance access [8].…”