Rural-urban differences in the symptoms, side effects, and physical activity of cancer survivors in the United States

To evaluate rural-urban differences in cancer-related symptoms, side effects, activities of daily living, and physical activity among cancer survivors in the United States.

We analyzed the Health Information National Trends Survey -Surveillance Epidemiology End Results (HINTS -SEER; n = 1054 cancer survivors) from the Greater San Francisco Bay Area, Iowa, and New Mexico between January - August 2021. Respondents were surveyed on cancer-related symptoms and side effects along with their activities of daily living (ADL) and physical activity (PA). We calculated weighted percentages and Rao-Scott chi-square tests for reported differences between rural and urban survivors. Rural/urban status was determined using Rural Urban Continuum Codes.

Rural and urban cancer survivors did not differ in their reporting of symptoms or side effects, with each group reporting approximately 20 % or greater prevalence of each assessed symptom or side effect. For ADLs, rural cancer survivors more frequently reported difficulty dressing/bathing compared to their urban counterparts (7.7 % vs. 3.1 %, p = 0.02), but there were no statistically significant differences for other ADLs. A higher percentage of urban cancer survivors compared to rural reported meeting aerobic PA recommendations of ≥150  minutes moderate intensity activity per week (47.9 % vs. 33.8 %, p < 0.001).

While many cancer survivors report symptoms and side effects of cancer treatment, no substantial variations existed by rurality. Important exceptions to this was that rural cancer survivors reported greater difficulty with bathing and dressing, and lower PA. Interventions and research to address these rural-urban differences will be critical to ensure rural cancer survivors have optimal long-term outcomes.