Rural cancer patients often have a harder time dealing with a cancer diagnosis… and all of the issues following diagnosis and treatment. New research sheds a light on what it means to them.
By Stephanie Soucheray
In November of 2010, Beck Gross, then 34, was taking a shower when she noticed a lump on her breast.
It was the worst-case scenario: aggressive, HER2-positive breast cancer. Gross, who was then living in Oxford, had to travel to Duke University to get treatment – an hour commute – and sometimes her chemotherapy infusions would last eight hours.
“I had to have someone drive with me,” said Gross. “I was just so tired.”
The long commute wasn’t the only problem with Gross receiving cancer treatment in an urban center far from her rural home. She and her husband couldn’t make all of the cancer-support groups she wanted to participate in.
“I just wasn’t strong enough,” Gross said. “And there were other things – exercise trials, for example – that I wanted to do, but I lived too far away.”
Research from Wake Forest Baptist Medical Center released last month provided some insight into the issues Gross has faced, and also looked more broadly at the difference between rural and urban health care.
In particular, the study examined the health behaviors of adult cancer survivors in rural and urban settings, and found that these survivors had very different – and risky – lifestyle factors.
“We found that rural survivors were more likely to smoke and were more sedentary,” said Kathryn E. Weaver, assistant professor of social sciences and health policy at Wake Forest Baptist and author of the study, which was published in Cancer Causes & Control. “And survivors who smoked reported worse health and were more likely unemployed.”
Weaver used data from the 2006-10 National Health Interview Survey, a population-based sample of adults conducted by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.
She said the 1,642 rural and 6,000 urban patients are representative of urban and rural patient populations across the country, and that her interest in these questions came from her work at the Wake Forest Comprehensive Cancer Center.
“We pull from a largely rural area,” Weaver said, primarily from the western half of the state. “We needed to get a better sense of who our rural cancer survivors are and what they are facing.”
Weaver said both smoking and being sedentary are health factors and behaviors that link cancer survivors to subsequent cancer diagnoses and survival rates. She said previous studies have showed that rural cancer patients were more likely to be uninsured, and that access to care is a considerable issue for this patient population.
“In my own clinical practice, I’ve seen patients who have to drive an hour to get to the Cancer Center,” Weaver said. “They routinely live more than 60 miles away.”
All types of cancer and diagnoses were featured in the study, and all participants were over the age of 18. Rural cancer survivors were not, on average, older than their urban counterparts or more obese, but they were less educated.
The study also showed that rural cancer survivors reported poorer overall health, at a rate of 37 percent as compared to 27 percent for urban survivors.
Fifty-one percent of rural survivors reported doing no regular physical activity, compared to 39 percent for urban survivors. In the study, the authors note that many older people exercise in a gym or fitness-walk in a mall, facilities that may not be available to the rural population.
Grocery stores with high-quality produce are also few and far between in rural settings.
“I wanted to eat healthy and organic produce when I was going through treatment,” said Gross, who is currently cancer-free. “But my husband would have to drive all the way to Durham or Raleigh to get to a Whole Foods. We just didn’t have that in Oxford.”
Weaver said she hopes her study can help open the conversation about meeting patients’ needs where they live. She said telecounseling for smoking cessation and at-home fitness routines should be part of a post-cancer patient education for rural survivors.
“Meeting patients where they are has to be a priority,” said Weaver.
The number of rural cancer survivors in the United States is 2.8 million.
Cover photo: Nicholas T, courtesy flickr creative commons