Preferences for breast cancer survivorship care by rural/urban residence and age at diagnosis



Preferences for survivorship care among recently treated breast cancer survivors may vary by rural-urban residence and age, but potential differences have not been examined.


We conducted a cross-sectional survey of survivorship preferences among women treated for non-metastatic breast cancer 6–24 months prior to recruitment.


We surveyed 203 women (66% response) with American Joint Committee on Cancer Stage I or II breast cancer. Rural residents comprised 36.5% of respondents (82.7% White, non-Hispanic; 52.5% < college education) and 29.6% were ≥ 65 years. More than 95% indicated that checking for recurrence, receiving additional treatment, evaluation of side effects, and identification of late effects were “very important” reasons for follow-up care. The most common topics identified as “very important” for survivorship care discussions were recommendations for healthy behaviors (65.3%), best sources for breast cancer information (65.3%), and effects on family (53.3%) and job (53.8%). Women 65 years and older preferred to discuss follow-up care at the time of diagnosis (p = 0.002), with younger women preferring during (32%) or after treatment (39.1%). Rural survivors were significantly more likely to identify follow-up care reasons not related to the initial breast cancer as “very important” than urban survivors, including screening for other cancers, and examinations or tests for non-cancer diseases (both p = 0.01).


Survivorship care in accordance with national recommendations will likely be accepted by breast cancer survivors. Tailoring breast cancer survivorship care by timing, integration of primary care services, and specific psychosocial topics may best meet the needs of different ages and demographics.

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We gratefully acknowledge the contributions of Dr. Douglas Case to the study design and analytic plan. Dr. Julia Lawrence contributed to the study while on the faculty at Wake Forest School of Medicine and is currently employed by Novella Clinical. This study was conducted while Dr. Geiger was employed at Wake Forest School of Medicine


This work was financially supported by the National Institutes of Health [1R21CA155932]. The authors wish to acknowledge the support of the Wake Forest Baptist Comprehensive Cancer Center, supported by the National Cancer Institute’s Cancer Center Support Grant award number P30CA012197. Chandylen Nightingale’s work on this manuscript was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of health (UL1TR001420).

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Correspondence to Kathryn E. Weaver.

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This study was approved by the Wake Forest Health Sciences Institutional Review Board (IRB). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The Wake Forest Health Sciences Institutional Review Board approved the study with a waiver of written informed consent.


The opinions expressed in this article are the authors’ own and do not reflect the views of the National Cancer Institute, National Institutes of Health, the Department of Health and Human Services, or the United States government.

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Weaver, K.E., Nightingale, C.L., Lawrence, J.A. et al. Preferences for breast cancer survivorship care by rural/urban residence and age at diagnosis. Support Care Cancer 28, 3839–3846 (2020).

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  • Breast cancer
  • Survivorship
  • Rural
  • Geriatrics
  • Psychosocial
  • Follow-up care