In Rural Areas, a More Fatalistic View of Cancer

Compared to adults who live in urban areas of the United States, adults in rural areas were more likely to think fatalistically about cancer and feel overwhelmed by the information about cancer prevention, according to results published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research. 

People in rural areas are more likely to take fatalistic attitudes such as “It seems like everything causes cancer” and “There’s not much you can do to lower your chances of getting cancer;” are more likely to feel overloaded with information about cancer; and are more inclined than urban residents to think that cancer usually results in death, the study found. 

Adults living in rural areas have less access to healthcare facilities and experience a disproportionate burden from a variety of diseases, including cancer, compared to their urban counterparts, said Jacob Jensen, PhD, study senior author, professor in the Department of Communication at the University of Utah, and member of the Huntsman Cancer Institute.

“Addressing this disparity is difficult on multiple levels, but perhaps most challenging is that rural adults often bypass cancer prevention and detection resources when they are made available. Trying to understand the reasons behind this behavior is a pressing task for cancer researchers,” Dr. Jensen said. “Our research hypothesis was that beliefs and attitudes about cancer may be the underlying cause, and that rural adults might be more prone to negative beliefs about cancer, possibly as a way to cope with limited access and resources.”

To assess whether cancer beliefs vary between rural and urban adults in the U.S., Dr. Jensen and colleagues analyzed the results of a survey conducted between 2016 and 2020 in 12 U.S. National Cancer Institute-designated cancer centers.

Using online and in-person survey instruments, the researchers surveyed 10,362 participants (3,821 rural and 6,541 urban) living in the service areas of these cancer centers. The fraction of rural respondents ranged from 5.7 to 82.6 percent, depending on the catchment. Participants were asked to rate four statements related to prevention-focused cancer fatalism, cancer information overload, and treatment-focused cancer fatalism. 

The response options included “strongly agree,” “somewhat agree,” “somewhat disagree,” and “strongly disagree.”

The researchers found that, compared to urban participants, rural participants in the study were significantly more likely to respond that they agreed or strongly agreed with all four beliefs, showing that rural populations exhibited higher levels of cancer fatalism and cancer information overload. 

In particular, rural participants were 29 percent more likely to agree that everything causes cancer, 34 percent more likely to agree that prevention is not possible, 26 percent more likely to agree that there are too many different recommendations about cancer prevention, and 21 percent more likely to agree that cancer is always fatal.

“Our findings are in line with previous research showing that this type of thinking might be a consequence of a wider cultural setup that fosters self-reliance and coping in response to stress and lack of resources,” said Dr. Jensen. “This suggests that empathy could be the starting point for an effective communication approach, and that health communicators could engage rural populations by acknowledging these feelings.”

Among the limitations of the study, the authors acknowledged that fatalism and information overload may not be exclusive to cancer and may affect the risk of other health conditions, such as heart disease and diabetes.