The findings are based on surveys done among 1,155 cancer survivors in Vermont who had been working at the time of their diagnosis. This is one of the largest surveys to date to address employment issues in cancer survivors.

The research team found no significant differences in the proportions of rural and urban survivors working fewer hours, experiencing a career change or who were unable to work. However, rural cancer patients were 66 percent more likely to retire early as a result of their diagnosis than their urban counterparts.

This disparity is ascribed to the fact that rural populations tend to engage in more physically demanding jobs, for instance in construction, agriculture, forestry and mining, which they are unable to pursue after their cancer treatment.

Another finding is that cancer survivors in rural areas were 33 percent less likely to go on paid disability while receiving cancer treatment than their urban counterparts of similar age, education and cancer stage. The types of manual labor available in rural areas rarely offer disability benefits and therefore increase the impact of cancer diagnosis for this population. According to the Department of Labor, only 33 percent of persons employed in manual labor jobs (natural resources, construction, and maintenance) are offered short-term disability and only 21 percent are offered long-term disability as part of their benefits. In contrast, more than half of all management or professional workers are offered some form of disability.

The research team believes it is imperative for clinicians to recognize the impacts that a cancer diagnosis might have on America's rural population, which makes up 20 percent of the country's inhabitants.

"Providers who care for rural patients must recognize that these patients may be at an increased risk for financial impact. Cancer care for these patients should incorporate counseling services related to returning to work after active treatment and assistance related to disability," writes Sowden. "It is possible that survivorship programs could lead this charge, with employment counseling becoming a standard part of this post-treatment phase of care."