Abstract

Purpose This study examined rural and urban parents’ reports of their children’s receipt of general follow-up care and psychological services, ratings of the acceptability of common sources of follow-up care, and ratings of local/nearby follow-up care access and effectiveness.

Methods A cross-sectional, quantitative survey was conducted among 238 (139 urban, 46 rural adjacent, and 53 rural non-adjacent) parents of childhood cancer survivors (ages 2–17 and at least 2 years since cancer diagnosis) recruited through the Kentucky Cancer Registry. Bivariate analyses and multivariable logistic regressions adjusting for predisposing, enabling, and need factors tested for differences across residence in urban counties, rural counties adjacent to an urban county, and rural counties non-adjacent to an urban county.

Results Children in rural adjacent counties had higher adjusted odds of receiving psychological services (OR 4.37; 95% CI 1.45, 13.22) than children in urban counties. Parents of children in non-adjacent counties had lower adjusted odds of agreeing that they could obtain local/nearby follow-up care for their child (OR 0.15; 95% CI 0.06, 0.36) and that local follow-up care was effective (OR 0.22; 95% CI 0.10, 0.48) than parents of children in urban counties.

Conclusions The study findings provide a comprehensive yet complex picture of similarities and differences in children’s follow-up care access according to their rurality of residence. Children residing in rural areas adjacent to an urban area have better access to psychological services than children residing in urban areas. However, parents of children residing in rural areas non-adjacent to an urban area have worse ratings of the accessibility and effectiveness of local follow-up care.

Implications for Cancer Survivors Psychological services may need to be expanded for childhood cancer survivors in both rural and urban areas to ensure equitable access. The accessibility and quality of local services may need to be improved to encourage the use of local follow-up care among children residing in rural areas that are non-adjacent to an urban area.

Document Type

Article

Publication Date

2026

Notes/Citation Information

© The Author(s) 2026

Digital Object Identifier (DOI)

https://doi.org/10.1007/s11764-025-01942-x

Funding Information

This study was supported by P30CA177558-09S2 and P30CA177558 from the National Cancer Institute, including support from the Cancer Research Informatics Shared Resource. The REDCap system used in the study was supported by the National Center for Advancing Translational Sciences through grant number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Health Institutes.

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