Supportive Care in Cancer

, Volume 28, Issue 2, pp 633–643 | Cite as

Differences in the health, mental health and health-promoting behaviours of rural versus urban cancer survivors in Australia

  • Kate M. GunnEmail author
  • Narelle M. Berry
  • Xingqiong Meng
  • Carlene J. Wilson
  • James Dollman
  • Richard J. Woodman
  • Robyn A. Clark
  • Bogda Koczwara
Original Article



People affected by cancer who live in rural Australia experience inferior survival compared to their urban counterparts. This study determines whether self-reported physical and mental health, as well as health-promoting behaviours, also differ between rural and urban Australian adults with a history of cancer.


Weighted, representative population data were collected via the South Australian Monitoring and Surveillance System between 1 January 2010 and 1 June 2015. Data for participants with a history of cancer (n = 4295) were analysed with adjustment for survey year, gender, age group, education, income, family structure, work status, country of birth and area-level relative socioeconomic disadvantage (SEIFA).


Cancer risk factors and co-morbid physical and mental health issues were prevalent among cancer survivors regardless of residential location. In unadjusted analyses, rural survivors were more likely than urban survivors to be obese and be physically inactive. They were equally likely to experience other co-morbidities (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, arthritis or osteoporosis). With adjustment for SEIFA, rural/urban differences in obesity and physical activity disappeared. Rural survivors were more likely to have trust in their communities, less likely to report high/very high distress, but equally likely to report a mental health condition, both with and without adjustment for SEIFA.


There is a need for deeper understanding of the impact of relative socioeconomic disadvantage on health (particularly physical activity and obesity) in rural settings and the development of accessible and culturally appropriate interventions to address rural cancer survivors’ specific needs and risk factors.


Cancer Onco- Rural Regional Survivor Disparity Psych- 



Dr. Kate Gunn was supported by a Cancer Council SA Postdoctoral Research Fellowship (Cancer Support) and a Churchill Fellowship, Professor Bogda Koczwara was supported by a National Breast Cancer Foundation Practitioner Fellowship and Professor Robyn Clark by a Heart Foundation Future Leader Fellowship, during the completion of some of this work.

Compliance with ethical standards

Ethics approval to use the data for this purpose was granted by the SA Health Human Research Ethics Committee (reference number HREC/15/SAH/100), and participants gave verbal informed consent prior to participating in the survey.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University of South Australia Cancer Research InstituteAdelaideSouth Australia
  2. 2.Flinders Centre for Innovation in Cancer, College of Medicine and Public HealthFlinders UniversityAdelaideAustralia
  3. 3.Department of Rural HealthUniversity of South AustraliaAdelaideAustralia
  4. 4.College of Nursing and Health SciencesFlinders UniversityAdelaideAustralia
  5. 5.Norwich Medical SchoolUniversity of East AngliaNorwichUK
  6. 6.Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public HealthFlinders UniversityAdelaideAustralia
  7. 7.School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
  8. 8.Alliance for Research in Exercise, Nutrition and ActivityUniversity of South AustraliaAdelaideAustralia

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