Disparities in Mental Health Outcomes Between Rural and Nonrural Lung Cancer Survivors

Healthy People 2010 establishes an agenda for improving the nation's physical and mental health. One of the goals of Healthy People 2010 is the elimination of disparities in physical and mental health due to certain population characteristics such as race/ethnicity, gender, socioeconomic status or geographic area of residence. It is well known that cancer diagnosis and treatment can significantly affect an individual's mental health. However, very little research has examined whether disparities might exist in these mental health outcomes across certain groups of cancer patients and survivors. In particular, disparities in mental health outcomes due to whether a cancer patient or survivor resides in a rural area has received little attention - this question has never been examined in lung cancer survivors. Lung cancer survivors bear a considerable physical and mental health burden. Lung cancer survivors residing in rural areas are likely to have fewer resources available to them to cope with this burden relative to lung cancer survivors residing in nonrural areas. Thus, the likelihood that significant disparities exist in mental health outcomes 2S a function of whether a lung cancer survivor resides in a rural or nomural area is high. Consequently, examination of the possibility that rural survivors might shoulder a disproportionate share of the mental health burden posed by lung cancer (Study Aim 1) represents a significant area of study Furthermore, identification of factors (intrapersonal, interpersonal, informational, tangible) potentially associated with disparities in mental health outcomes among lung cancer survivors (Study Aims 2 and 3) can provide a blueprint for the design of interventions to reduce these disparities. Rural (n=150) and nomural (n=150) non-small-cell lung cancer (NSCLC) survivors will be recruited from the population-based statewide SEER Kentucky Cancer Registry (KCR). 2003 USDA Rural-Urban Continuum codes will classify survivors as rural (codes 7-9) or nomural (codes 1-6) based on county of residence. Survivors will complete a telephone interview and questionnaire packet about 10-15 months post-diagnosis. Information regarding a variety of negative (Le., distress) and positive (Le., growth) mental health outcomes will be obtained as will information regarding factors (intrapersonal, interpersonal, informational, tangible) potentially linked to disparities in mental health outcomes. Analyses will focus upon identification of: (a) the nature and magnitude of disparities in mental health outcomes in NSCLC survivors linked to rural residence (Aim 1); and (b) differences between rural and nomural NSCLC survivors in resources (intrapersonal, interpersonal, informational, tangible) potentially linked to observed disparities in mental health outcomes (Aims 2 and 3).