Disparities in Psychosocial Outcomes Among Pediatric Cancer Survivors Living in Rural and Appalachian Areas

Little is known about psychosocial outcomes in pediatric cancer based on the area of residency. Therefore, we longitudinally examined differences in the adjustment of children with cancer living in rural and Appalachian areas relative to urban and non-Appalachian children.

Data were from a larger study of coping and communication in families of children with cancer (n = 336; M_age = 10.69). Rural (n = 118) and Appalachian (n = 58) residency were based on federal codes. Mothers, fathers, and children reported on child internalizing problems, externalizing problems, and total competence near diagnosis and 1 year later.

Children with cancer exhibited significant increases in behavioral and emotional difficulties by 1 year post-diagnosis, as reported by all three sources. There were no group differences in behavioral and emotional problems at diagnosis nor in change from diagnosis to 1 year based on rural or Appalachian residency. At 1 year post-diagnosis, children from rural areas had significantly lower social competence based on mother (b = -0.77, p = 0.02) and child reports (b = -1.27, p = 0.02). Additionally, at 1 year post-diagnosis, fathers reported children in Appalachian counties had significantly lower total competence (b = -2.35, p = 0.04) and social competence (b = -1.32, p = 0.03) than non-Appalachian peers.

Survivors in rural and Appalachian areas may experience greater social difficulties 1 year post-diagnosis than those in more urban areas. Clinicians should routinely assess survivors' access to mental health and follow-up care. Future research should examine cultural barriers and beliefs that may contribute to these disparities.