Supportive Care in Cancer

, Volume 23, Issue 5, pp 1285–1294 | Cite as

Use of cancer-specific mental health resources—is there an urban-rural divide?

  • Anna BeraldiEmail author
  • Ene Kukk
  • Alexandra Nest
  • Gabriele Schubert-Fritschle
  • Jutta Engel
  • Pia Heußner
  • Peter Herschbach
Original Article



The purpose of this study is to establish whether mental health (MH) outcomes, attitudes towards cancer-specific MH (CSMH) resources, and the availability of such resources differ between rural and urban cancer patients.


Three months after surgery for colorectal cancer, patients received a questionnaire for completion at home assessing distress, depression, anxiety, acceptance, knowledge and use of CSMH resources and the doctor-patient relationship. We adjusted our sample to reference data of the Munich Cancer Registry and documented CSMH resources (e.g. cancer-specific information centres and cancer support groups) using a systematic Internet search.


Five hundred thirty-four patients participated with a mean age of 68.9 years; 44.5 % were female. Urban patients talked less with their doctor about their emotional state (65 %, p < 0.01) and showed poorer knowledge of CSMH resources (60 %, p < 0.002). A good doctor-patient relationship was associated with a better MH outcome. A significant predictor for acceptance was distress. Ninety-four percent of patients without a nearby support facility lived in rural areas (p < 0.001). There were no group differences concerning distress, MH outcomes, or acceptance of CSMH resources.


Despite a higher availability of CSMH resources, urban patients showed poorer doctor-patient relationships and less knowledge of such resources than rural patients. Overall, knowledge and use of these resources were poor. The amount of support facilities available therefore appears to be less important than establishing an efficient communication network between patients, doctors and providers of CSMH resources to achieve satisfaction with treatment of urban and rural cancer patients.


Colorectal cancer Mental health Urban-rural divide Doctor-patient relationship 



This study was funded by the Munich Cancer Center (Tumorzentrum München). We thank all head physicians who accepted to cooperate in this study and all surgeons who supported it by patient recruitment.

Conflict of interest

The authors have no conflict of interest to declare. The authors have full control of all primary data and allow the journal to review the data if requested.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Anna Beraldi
    • 1
    • 2
    Email author
  • Ene Kukk
    • 2
    • 5
  • Alexandra Nest
    • 4
  • Gabriele Schubert-Fritschle
    • 3
  • Jutta Engel
    • 3
  • Pia Heußner
    • 1
  • Peter Herschbach
    • 4
    • 5
  1. 1.Medical Clinic and Policlinic III, Psycho-OncologyUniversity Hospital Grosshadern, Ludwig-Maximilians-Universität MünchenMunichGermany
  2. 2.Munich Cancer Center (MCC)MunichGermany
  3. 3.Munich Cancer Registry (MCR)IBE/University Hospital GrosshadernMunichGermany
  4. 4.Roman-Herzog Comprehensive Cancer Center (RHCCC)Klinikum rechts der Isar, Technische Universität MünchenMunichGermany
  5. 5.Division of Psychosocial Oncology, Department of Psychosomatic Medicine and PsychotherapyKlinikum rechts der Isar, Technische Universität MünchenMunichGermany

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