• cancer;
  • oncology;
  • healthcare disparities;
  • mental health;
  • rural health


Objective: While much research has sought to identify disparities in cancer incidence, survival, and treatment, little research has sought to identify disparities in mental health (MH) outcomes among cancer survivors. The present study aims to identify disparities in MH outcomes between rural and nonrural cancer survivors.

Methods: Cancer survivors who met eligibility criteria were identified through the Kentucky SEER Cancer Registry. Rural status was determined by 2003 USDA Rural–Urban Continuum Codes. 116 (n=54 rural, 62 nonrural) survivors with diagnoses of breast (n=42), hematologic (n=39), or colorectal (n=35) cancer completed mail-back questionnaires and/or a telephone interview.

Results: Rural cancer survivors reported poorer MH functioning (effect size (ES)=0.45 SD), greater symptoms of anxiety (ES=0.70) and depression (ES=0.47), greater distress (ES=0.41), and more emotional problems (ES=0.47) than nonrural cancer survivors. Rural and nonrural cancer survivors did not differ consistently in regard to positive MH outcomes, such as benefit finding. The pattern of results was maintained when adjusted for education and physical functioning.

Conclusions: Clinically important disparities in MH outcomes were evident between rural and nonrural cancer survivors. Interventions aimed at raising access and utilization of MH services may be indicated for cancer survivors in rural areas. Copyright © 2009 John Wiley & Sons, Ltd.