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


Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Gray, MS; Judd, SE; Sloane, R; Snyder, DC; Miller, PE; Demark-Wahnefried, W

Published Date

  • April 2019

Published In

Volume / Issue

  • 30 / 4

Start / End Page

  • 301 - 309

PubMed ID

  • 30783858

Pubmed Central ID

  • 30783858

Electronic International Standard Serial Number (EISSN)

  • 1573-7225

International Standard Serial Number (ISSN)

  • 0957-5243

Digital Object Identifier (DOI)

  • 10.1007/s10552-019-01141-x


  • eng