Cancer Causes & Control

, Volume 30, Issue 4, pp 301–309 | Cite as

Rural–urban differences in health behaviors and outcomes among older, overweight, long-term cancer survivors in the RENEW randomized control trial

  • Marquita S. Gray
  • Suzanne E. Judd
  • Richard Sloane
  • Denise C. Snyder
  • Paige E. Miller
  • Wendy Demark-WahnefriedEmail author
Original Paper



Rural cancer survivors (RCS) have poorer health outcomes and face multiple challenges—older age, and limited transportation, education, income, and healthcare access. Yet, RCS are understudied. The Reach-out to ENhancE Wellness(RENEW) trial, a home-based, diet and exercise intervention among 641 breast, prostate, and colorectal cancer survivors addressed many of these challenges.


We examined whether rural and urban participants differed in their response to the RENEW intervention (e.g., physical functioning, quality-of-life, intakes of fruits and vegetables (F&V) and saturated fat, body mass index(BMI), physical activity, and adverse events).


Rural versus urban survivors report significantly more favorable mean (SE) changes in physical functioning [− 0.66 (1.47) v − 1.71 (1.00)], physical health [+ 0.14 (0.71) v − 0.74 (0.50)], and fewer adverse events [1.58 (0.08) v 1.64 (0.06)]. Rural versus urban survivors reported smaller increases in F&Vs [+ 1.47 (0.23) v + 1.56(0.16); p = 0.018], and lower percentages achieved goal behavior for endurance exercise and intakes of F&Vs and saturated fat.


The RENEW intervention reduced declines in physical health and functioning among RCS to a significantly greater extent than for urban cancer survivors. All survivors significantly improved intakes of F&V and saturated fat, and endurance exercise; however, lower percentages of rural versus urban survivors met goal suggesting that more intensive interventions may be needed for RCS.


Rural Cancer survivors Health outcomes Lifestyle interventions Health disparities 



The authors acknowledge the contributions of UAB Cancer Research Experiences for Students (CaRES) director, Dr. John Waterbor, and CaRES faculty and staff for their pioneering efforts to increase opportunities for students in cancer research. Most of all, we thank all of the RENEW study participants, who make these studies possible.


This study was funded by grants from the National Cancer Institute (R01CA81191 and R25CA076023).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of EpidemiologyUniversity of Alabama at Birmingham (UAB)BirminghamUSA
  2. 2.Department of BiostatisticsUABBirminghamUSA
  3. 3.Center for Aging and Human DevelopmentDuke University Medical CenterDurhamUSA
  4. 4.Duke University School of MedicineDurhamUSA
  5. 5.Cancer Epidemiology and Surveillance BranchTexas Department of State Health ServicesAustinUSA
  6. 6.Department of Nutrition SciencesUABBirminghamUSA

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