People affected by cancer who live in rural Australia experience inferior survival compared to their urban counterparts. This study determines whether self-reported physical and mental health, as well as health-promoting behaviours, also differ between rural and urban Australian adults with a history of cancer.
Weighted, representative population data were collected via the South Australian Monitoring and Surveillance System between 1 January 2010 and 1 June 2015. Data for participants with a history of cancer (n = 4295) were analysed with adjustment for survey year, gender, age group, education, income, family structure, work status, country of birth and area-level relative socioeconomic disadvantage (SEIFA).
Cancer risk factors and co-morbid physical and mental health issues were prevalent among cancer survivors regardless of residential location. In unadjusted analyses, rural survivors were more likely than urban survivors to be obese and be physically inactive. They were equally likely to experience other co-morbidities (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, arthritis or osteoporosis). With adjustment for SEIFA, rural/urban differences in obesity and physical activity disappeared. Rural survivors were more likely to have trust in their communities, less likely to report high/very high distress, but equally likely to report a mental health condition, both with and without adjustment for SEIFA.
There is a need for deeper understanding of the impact of relative socioeconomic disadvantage on health (particularly physical activity and obesity) in rural settings and the development of accessible and culturally appropriate interventions to address rural cancer survivors’ specific needs and risk factors.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Beesley V, Eakin E, Steginga S, Aitken J, Dunn J, Battistutta D (2008) Unmet needs of gynaecological cancer survivors: implications for developing community support services. Psycho-Oncology 17(4):392–400
Harrison JD, Young JM, Price MA, Butow PN, Solomon MJ (2009) What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer 17(8):1117–1128
Butow PN et al (2012) Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review. Support Care Cancer 20(1):1–22
Jong KE, Smith DP, Yu XQ, O’Connell DL, Goldstein D, Armstrong BK (2004) Remoteness of residence and survival from cancer in New South Wales. Med J Aust 180(12):618–622
Bydder SA, Spry NA (2011) Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in Queensland. Med J Aust 195(11–12):661–662
Yu XQ, Luo Q, Kahn C, O’Connell DL, Houssami N (2015) Temporal trends show improved breast cancer survival in Australia but widening urban–rural differences. Breast 24(4):524–527
Australian Institute of Health and Welfare, (2010) Cancer in Australia : an overview. 2010: Canberra
Baldwin AE, Usher K (2008) Going the distance--experiences of women with gynaecological cancer residing in rural remote North Queensland. Int J Nurs Pract 14(4):322–328
Gunn K, Turnbull D, McWha JL, Davies M, Olver I (2013) Psychosocial service use: a qualitative exploration from the perspective of rural Australian cancer patients. Support Care Cancer 21(9):2547–2555
Rogers-Clark C (2002) Living with breast cancer: the influence of rurality on women’s suffering and resilience. A postmodern feminist inquiry. Aust J Adv Nurs 20(2):34–39
McGrath P (2001) Returning home after specialist treatment for hematological malignancies: an Australian study. Fam Community Health 24(2):36–48
Coory MD, Baade PD (2005) Urban-rural differences in prostate cancer mortality, radical prostatectomy and prostate-specific antigen testing in Australia. Med J Aust 182(3):112–115
Craft PS, Buckingham JM, Dahlstrom JE, Beckmann KR, Zhang Y, Stuart-Harris R, Jacob G, Roder D, Tait N (2010) Variation in the management of early breast cancer in rural and metropolitan centres: implications for the organisation of rural cancer services. Breast 19(5):396–401
Lyons MA, Shelton MM (2004) Psychosocial impact of cancer in low-income rural/urban women: phase II. Online J Rural Nurs Health Care 4(2):6–23
Berry NM, Miller MD, Woodman RJ, Coveney J, Dollman J, Mackenzie CR, Koczwara B (2014) Differences in chronic conditions and lifestyle behaviour between people with a history of cancer and matched controls. Med J Aust 201(2):96–100
Eakin EG, Youlden DR, Baade PD, Lawler SP, Reeves MM, Heyworth JS, Fritschi L (2007) Health behaviors of cancer survivors: data from an Australian population-based survey. Cancer Causes Control 18(8):881–894
Elliott J, Fallows A, Staetsky L, Smith PWF, Foster CL, Maher EJ, Corner J (2011) The health and well-being of cancer survivors in the UK: findings from a population-based survey. Br J Cancer 105(SUPPL. 1):S11–S20
Hall AE, Sanson-Fisher RW, Carey ML, Paul C, Williamson A, Bradstock K, Campbell HS (2016) Prevalence and associates of psychological distress in haematological cancer survivors. Support Care Cancer 24(10):4413–4422
Reid-Arndt SA, Cox CR (2010) Does rurality affect quality of life following treatment for breast cancer? J Rural Health 26(4):402–405
Zahnd WE, et al., (2018) Rural–urban differences in cancer incidence and trends in the United States. AACR
Weaver KE et al (2012) Rural-urban disparities in health status among US cancer survivors. Cancer 119(5):1050–1057
Burris JL, Andrykowski M (2010) Disparities in mental health between rural and nonrural cancer survivors: a preliminary study. Psychooncology 19(6):637–645
Kennedy AE, et al., (2018) An overview of the National Cancer Institute’s initiatives to accelerate rural cancer control research, AACR
SA Health (2004) South Australian Monitoring and Survellance System (SAMSS) survey methodology. In: SAMSS Technical Paper Seried. Goverment of South Australia, Adelaide
Avery J, et al., South Australian Monitoring and Surveillance System (SAMSS): overall health status of South Australians as measured by the single item SF1 general health status question. 2006, Rundle Mall: South Australian Department of Health
Australian Institute of Health and Welfare, (2017) Cancer in Australia 2017
Bettencourt BA et al (2007) The breast cancer experience of rural women: a literature review. Psycho-Oncology 16(10):875–887
Jackson H et al (2007) Mental health problems in rural contexts: what are the barriers to seeking help from professional providers? Aust Psychol 42(2):147–160
Meadows G, Burgess P, Bobevski I (2002) Distributing mental health care resources: strategic implications from the National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 36(2):217–223
Zander A et al (2015) Active travel to work in NSW: trends over time and the effect of social advantage. Health Promot J Austr 25(3):167–173
Black G, Roberts RM, Li-Leng T (2012) Depression in rural adolescents: relationships with gender and availability of mental health services. Rural Remote Health 12:2092
Dr. Kate Gunn was supported by a Cancer Council SA Postdoctoral Research Fellowship (Cancer Support) and a Churchill Fellowship, Professor Bogda Koczwara was supported by a National Breast Cancer Foundation Practitioner Fellowship and Professor Robyn Clark by a Heart Foundation Future Leader Fellowship, during the completion of some of this work.
Ethics approval to use the data for this purpose was granted by the SA Health Human Research Ethics Committee (reference number HREC/15/SAH/100), and participants gave verbal informed consent prior to participating in the survey.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Gunn, K.M., Berry, N.M., Meng, X. et al. Differences in the health, mental health and health-promoting behaviours of rural versus urban cancer survivors in Australia. Support Care Cancer 28, 633–643 (2020) doi:10.1007/s00520-019-04822-0