Abstract A62: Post-treatment follow-up care and health-related information needs among rural breast, prostate, and colorectal cancer survivors
Authors: Weaver Kathryn E. , Avis Nancy , Palmer Nynikka , Fitzgerald Nora , Tooze Janet 
Published: May 2015

Purpose: Rural compared to urban residence is associated with worse health outcomes after a cancer diagnosis, including greater distress, higher prevalence of negative health behaviors, lower self-reported health, and increased mortality. Prior studies have suggested that rural residents may have greater cancer-related information needs compared to their urban counterparts, yet little is known about the most common health-related information needs among rural cancer survivors and predictors of greater information needs among this vulnerable sub-population of cancer survivors.

Methods: We identified breast, prostate, and colorectal cancer survivors from an institutional cancer registry who: 1) currently resided in a rural zip code (defined as non-metro according to the USDA Rural-Urban Commuting Area coding system), 2) had non-metastatic disease with no treatment in the past 12 months, and 3) were 2-5 years post-diagnosis. Participants completed a survey via mail or telephone on post-treatment follow-up care received and health needs. They were asked about discussions with follow-up care providers regarding weight, diet, exercise, smoking, and health behavior change to create a health promotion score (ranging from 0-100% of topics covered). Participants were queried about 24 health-related information needs in 8 domains (tests and treatment, side effects and symptoms, health promotion, fertility, interpersonal, occupation, emotional, and insurance) drawn from prior National Cancer Institute survivor surveys. Poisson regression models were used to assess relationships between demographic and cancer characteristics, follow-up care components received, and number of health-related information needs.

Results: The majority of eligible respondents (N=170: 41% breast, 43% prostate, 16% colorectal; mean age= 66 ± 10 years) were non-Hispanic white (91.8%) and reported less than a college education (66.7%). Inadequate financial resources were reported by 13.7% of the sample. A large majority of rural survivors reported cancer-related follow-up care in the past year (86.5%), generally by oncology or other specialists exclusively (57.0%) or both oncology and primary care (18.9%). Only half of rural survivors reported any discussion about mental health after treatment (49.0%), and 39.1% reported a detailed discussion about treatment side effects. The median health promotion score was only 36.7%. Survivors reported an average of 4.0 information needs (±4.5) in 1.6 different domains (±1.8). The most common domains of information needs included side effects and symptoms (57.6% with at least one need), health promotion (53.5%), tests and treatment (40.9%), and interpersonal concerns (30.1%). A greater number of information needs were reported by survivors who were younger [rate ratio(RR) compared to 5-years older = 1.11, 95% CI 1.01-1.20], ethnic or racial minority (RR= 1.89, 95% CI 1.17-3.06], and financially stressed [RR=1.87, 95% 1.25-2.81].

Discussion: Although the vast majority of rural survivors report receipt of post-treatment follow-up care, survivors may not be receiving key components such as mental health screening and health promotion advice. Rural cancer survivors still report health-related information needs several years post-treatment and may benefit from survivorship educational interventions focused on side effect monitoring and management and health promotion. Younger, ethnic minority, and low income rural survivors may especially benefit from education interventions to address information needs.

Citation Format: Kathryn E. Weaver, Nancy Avis, Nynikka Palmer, Nora Fitzgerald, Janet Tooze. Post-treatment follow-up care and health-related information needs among rural breast, prostate, and colorectal cancer survivors. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A62. doi:10.1158/1538-7755.DISP13-A62