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

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Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

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.

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Acknowledgments

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.

Funding

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

Author information

Authors and Affiliations

  1. Department of Epidemiology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA

    Marquita S. Gray

  2. Department of Biostatistics, UAB, Birmingham, AL, USA

    Suzanne E. Judd

  3. Center for Aging and Human Development, Duke University Medical Center, Durham, NC, USA

    Richard Sloane

  4. Duke University School of Medicine, Durham, NC, USA

    Denise C. Snyder

  5. Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA

    Paige E. Miller

  6. Department of Nutrition Sciences, UAB, Birmingham, AL, USA

    Wendy Demark-Wahnefried

Authors
  1. Marquita S. Gray
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  2. Suzanne E. Judd
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  3. Richard Sloane
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  4. Denise C. Snyder
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Correspondence to Wendy Demark-Wahnefried.

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Gray, M.S., Judd, S.E., Sloane, R. et al. Rural–urban differences in health behaviors and outcomes among older, overweight, long-term cancer survivors in the RENEW randomized control trial. Cancer Causes Control 30, 301–309 (2019). https://doi.org/10.1007/s10552-019-01141-x

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  • DOI: https://doi.org/10.1007/s10552-019-01141-x

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