{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T05:12:24Z","timestamp":1792732344883,"version":"4.5.0"},"reference-count":34,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Patients with cancer living in rural areas face unique challenges in accessing comprehensive care. Limited research has characterized disparities between patients living in more versus less remotely rural areas. This study investigated differences in health outcomes between patients with advanced cancer residing in more versus less rural areas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A baseline cross\u2010sectional survey was collected as part of the Nurse AMIE study (NCT04673019). Rurality was defined using Rural Urban Commuting Area (RUCA) codes and the dichotomy for analysis was &lt;\u20097 (micropolitan) versus 7\u201310 (small town\/rural). Participants completed surveys (PROMIS; SF\u201036) and Short Physical Performance Battery (SPPB) assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      348 patients with advanced cancer from micropolitan (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009263) and small town\/rural areas (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200985) with multiple cancer types were included. Half the sample are men (52%), 95% are white, 49% have a high school education or less, and 46% are living on $50,000 or less annually. PROMIS scores showed small town\/rural residents had greater sleep disturbance (adjusted mean difference, \u22122.50; 95% CI, \u22124.46, \u22120.54;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013). SF\u201036 measures revealed worse physical functioning (adjusted mean difference, 7.69; 95% CI, 0.54, 14.84;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.035), pain (adjusted mean difference, 7.37; 95% CI, 0.61, 14.13;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033), general health perceptions (adjusted mean difference, 6.78; 95% CI, 1.22, 12.34;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017), social functioning (adjusted mean difference, 7.50; 95% CI, 0.39, 14.61;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.039), and energy\/fatigue (adjusted mean difference, 6.77; 95% CI, 0.53, 13.00;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034) among small town\/rural residents. While overall SPPB scores were not statistically significantly different, small town\/rural residents performed worse on chair stands (adjusted mean difference, 0.46; 95% CI, 0.12, 0.81;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with cancer in more rural areas experience worse health across multiple domains, consistent with gaps in cancer care delivery between more versus less rural environments. The findings underscore the need for targeted interventions to address intra\u2010rural health disparities in cancer care and survivorship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      identifier: NCT05221606\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.72033","type":"journal-article","created":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T05:41:04Z","timestamp":1781329264000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Worse Function and Symptoms Among the Most Rural Patients With Advanced Cancer: A Cross\u2010Sectional Analysis"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2400-2935","authenticated-orcid":false,"given":"Kathryn H.","family":"Schmitz","sequence":"first","affiliation":[{"name":"Division of Hematology Oncology, Department of Medicine University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Baker","sequence":"additional","affiliation":[{"name":"Division of Hematology Oncology, Department of Medicine University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Division of Hematology Oncology, Department of Medicine University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Celebre","sequence":"additional","affiliation":[{"name":"Division of Hematology Oncology, Department of Medicine University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charity G.","family":"Patterson","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and SHRS Data Center University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clair","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and SHRS Data Center University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha J.","family":"Werts\u2010Pelter","sequence":"additional","affiliation":[{"name":"Division of Hematology Oncology, Department of Medicine University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Stout","sequence":"additional","affiliation":[{"name":"American Cancer Society  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3794-1344","authenticated-orcid":false,"given":"Jennifer","family":"Moss","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine Penn State College of Medicine, the Pennsylvania State University  Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Calo","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Penn State College of Medicine  Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Sobolewski","sequence":"additional","affiliation":[{"name":"Division of Hematology Oncology, Department of Medicine University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawna E.","family":"Doerksen","sequence":"additional","affiliation":[{"name":"Division of Hematology Oncology, Department of Medicine University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.70011"},{"issue":"8","key":"e_1_2_13_3_1","first-page":"33","article-title":"Physical Late Effects in Adult Cancer Survivors","volume":"22","author":"Stricker C. 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