In the urban setting, 250 surveys were distributed at the OSU cancer survivor day, of which 107 (42.8%) completed surveys were returned. There were no refusals to participate among the 99 rural survivors approached from the Appalachia-based clinic during medical visits, a cancer survivor meeting, and a cancer survivor picnic. Included in both groups were survivors of breast, lung, colorectal, lymphoma, prostate, myeloma, cervical, leukemia, bone, and other types of cancer (e.g. head and neck, ovarian, bladder, etc). Rural survivors had less education (≤high school: 72.8% vs. 56.6%, p=0.026) and lower annual household incomes (<$40,000: 62.7% vs. 38.5%, p=0.003) compared to urban survivors (). Urban and rural survivors did not differ in terms of other demographic variables examined.
Demographic characteristics of cancer survivors (n=206)
The frequencies and ranking of the top ten needs by urban and rural survivors are listed in . Overall, rural survivors reported needs at a lower frequency than urban survivors. Interestingly, several needs (paying medical bills, tense or nervous, prayer, health insurance, support groups, and help talking to family and friends about cancer) reported in the top ten by rural cancer survivors were not in the urban survivors’ top needs. Top needs reported by urban survivors that were not in the top needs of rural survivors included help with a healthy diet, relaxation exercises and stress management, massage therapy, yoga, herbs and vitamins, and weight management. Although there are distinct differences in the needs for urban and rural cancer survivors, the two needs most frequently reported by both groups were focused on worry about cancer returning and concern about fatigue.
Frequencies and ranking of top ten needs by urban non-Appalachia and rural Appalachia survivors
Results focusing on the ten needs categories are listed in . Urban survivors reported more overall needs compared to rural survivors (urban: mean=12.07 vs. rural: mean=6.64, p<0.001), as well as more needs in the following categories: symptomology, emotional, healthy behaviors, relationships, relaxation and stress management, expressive arts, and spiritual.
Need categories (mean number) reported by urban non-Appalachia and rural Appalachia cancer survivors
Eighty-seven (81.3%) urban survivors and 72 (72.9%) rural survivors indicated that they searched for cancer information. Among survivors who reported that they searched for information, more survivors reported searching for information at the time of their diagnosis and during their cancer treatment compared to after completion of their treatment (). Interestingly, although fewer survivors reported searching for information after their cancer treatment, still over half of the cancer survivors who reported searching for cancer information searched for information after completion of their cancer treatment. More rural survivors reported looking for information during their cancer treatment compared to urban survivors (91.7% vs. 73.6%; p<0.01).
Sources of information reported among urban non-Appalachia (n=87) and rural Appalachia (n=72) cancer survivors who reported searching for cancer information at various times during treatment
At the time of diagnosis, the most frequent sources of information were brochures, the internet, and healthcare providers for both urban and rural survivors. Urban survivors used books (49.4% vs. 23.2%; p<0.01) and hospital’s patient library (15.6% vs. 4.3%; p<0.05) more often than the rural survivors, respectively. Rural survivors were more likely to obtain information from family members compared to urban survivors (29.0% vs. 14.3%; p<0.05).
Brochures, the internet, and healthcare providers continued to be the most commonly reported sources for both groups of survivors during cancer treatment. Also, as at the time of diagnosis, a significantly higher percentage of urban survivors used books (45.3% vs. 22.7%; p<0.01) and the hospital patient library (14.1% vs. 3.0%; p<0.05) for information during cancer treatment. Rural survivors reported using their healthcare provider significantly more than urban participants for information during cancer treatment (68.2% vs. 50.0%; p<0.05).
The most frequently reported sources of information following cancer treatment by urban survivors were brochures, healthcare providers, and cancer organizations. Rural cancer survivors reported the same main sources of information, as well as the internet. For this time period, urban survivors reported newspapers (32.6% vs. 8.1%; p<0.01) and brochures (63.0% vs. 29.7%; p<0.01) as an information source more frequently than rural cancer survivors.
Characteristics of the information seeking experience are listed in . Overall, only a small percent (<10%) of survivors reported wanting more information but not knowing where to find it, and there was no difference between urban and rural survivors. Rural survivors differed from urban survivors by reporting less effort to get the information they needed (p<0.05) and less concern about the quality of the information (p<0.01). Additionally, rural survivors reported having a harder time understanding the information they found (p<0.05).
Characteristics of information seeking experience by urban non-Appalachia and rural Appalachia cancer survivors