Rural–urban differences in health behaviors and outcomes among older, overweight, long-term cancer survivors in the RENEW randomized control trial
- 118 Downloads
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.
KeywordsRural 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.
- 5.Muskie School of Public Services (2004) Kaiser commission on Medicaid and the Uninsured, Health Insurance Coverage in Rural America. Kaiser Family Foundation, Washington, DCGoogle Scholar
- 6.Bennett KOB, Probst JC (2008) Health Disparities: a Rural—Urban ChartbookGoogle Scholar
- 13.Underwood JM, Townsend JS, Stewart SL, Buchannan N, Ekwueme DU, Hawkins NA, Li J, Peaker B, Pollack LA, Richards TB, Rim SH, Rohan EA, Sabatino SA, Smith JL, Tai E, Townsend GA, White A, Fairley TL (2012) Surveillance of demographic characteristics and health behaviors among adult cancer survivors–Behavioral Risk Factor Surveillance System, United States, 2009. MMWR 61:1–23Google Scholar
- 16.Miller PE, Morey MC, Hartman TJ, Snyder DC, Sloane R, Cohen HJ, Demark-Wahnefried W (2012) Dietary patterns differ between urban and rural older, long-term survivors of breast, prostate, and colorectal cancer and are associated with body mass index. J Acad Nutr Diet 112:824–831CrossRefGoogle Scholar
- 19.Morey MC, Snyder DC, Sloane RC, Cohen HJ, Peterson B, Hartman TJ, Miller P, Mitchell DC, Demark-Wahnefried W (2009) Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. JAMA 301:1883–1891CrossRefGoogle Scholar
- 20.Snyder DC, Morey MC, Sloane RC, Stull V, Cohen HJ, Peterson B, Pieper C, Hartman TJ, Miller PE, Mitchell DC, Demark-Wahnefried W (2009) Reach out to ENhancE Wellness in Older Cancer Survivors (RENEW): design, methods and recruitment challenges of a home-based exercise and diet intervention to improve physical function among long-term survivors of breast, prostate, and colorectal cancer. Psycho-oncol 18:429–439CrossRefGoogle Scholar
- 21.Demark-Wahnefried W, Morey MC, Sloane R, Snyder DC, Miller PE, Hartman TJ, Cohen HJ (2012) Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. J Clin Oncol 30:2354–2361CrossRefGoogle Scholar
- 22.Rural Health Research Center (2006) Rural-urban commuting area codes (version 2.0)Google Scholar
- 28.Hawkes AL, Chambers SK, Pakenham KI, Patrao TA, Baade PD, Lynch BM, Aitken JF, Meng X, Courneya KS (2013) Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomized controlled trial. J Clin Oncol 31:2313–2321CrossRefGoogle Scholar
- 31.Golsteijn RHJ, Bolman C, Peels DA, Volders E, de Vries H, Lechner L (2017) Web-based and print-based computer-tailored physical activity intervention for prostate and colorectal cancer survivors: a comparison of user characteristics and intervention use. J Med Internet Res 19:e298. https://doi.org/10.1186/s12966-018-0734-9 CrossRefGoogle Scholar
- 35.Krout JA (1994) An overview of older rural populations and community-based services, Providing community-based services to the rural elderly. In: Glasgow N, Berry EH Rural Aging in 21st Century America. Springer, New York, pp 3–18Google Scholar
- 41.Thompson FE, Midthune D, Subar AF, McNeel T, Berrigan D, Kipnis V (2000) Dietary intake estimates in the national health interview survey: methodology, results, and interpretation. J Acad Nutr Diet 105:352–363Google Scholar