The study, led by Christine M. Gunn of The Dartmouth Institute for Health Policy and Clinical Practice, took a deliberately comprehensive approach. The research team identified all adults diagnosed with solid tumors between 2022 and 2024 who received treatment at Dartmouth Cancer Center locations, assembling a cohort of 8,772 patients. From electronic health records, they extracted demographics, visit patterns, referrals, and questionnaire responses, building a quantitative portrait of how this predominantly rural population actually interacts with digital care. On top of that record-based analysis, the team sent a survey to a random sample of patients stratified by tumor type, probing digital health readiness, service use, satisfaction, and appetite for digital programming. The survey yielded 207 respondents, whose answers were summarized descriptively to capture the shape of demand for virtual services.

The numbers that emerged from the health record tell a story of selective, specialty-dependent telehealth adoption. Behavioral health stood out dramatically: 76 percent of behavioral health visits were delivered via telehealth, making virtual care the dominant modality for mental health support in this population. Cancer-directed specialties, by contrast, delivered fewer than 5 percent of their visits through telehealth. That split is revealing. It suggests that when patients face barriers to accessing behavioral health services, whether transportation, scheduling, stigma, or distance, telehealth becomes a lifeline they readily adopt. But when it comes to oncology appointments themselves, where physical examination, infusion coordination, and established relationships with medical teams matter, both clinicians and patients have largely stayed with in-person care. Digital adoption, in other words, is not a binary trait of a population but a function of what each service demands and what each patient needs.

Survey responses reinforced the picture of engaged but selective users. Among the 207 respondents, 42 percent reported using a patient portal often or always to manage their care, a substantial share for any patient population, rural or urban. Perhaps the most methodologically interesting finding concerned digital health readiness, a construct measured with validated instruments that assess patients’ comfort, skills, and infrastructure for engaging with digital tools. The researchers expected readiness scores to predict who used the portal and who wanted more digital services. Instead, digital health readiness was not associated with either portal use or interest in digital offerings. That null result carries real weight: it implies that interest in virtual survivorship care is broad-based rather than confined to the digitally fluent, and that screening patients for digital readiness may not identify who will benefit from digital programs.

To understand why patients wanted digital services, and what they hoped those services would accomplish, the team turned to qualitative methods. Twenty-five survivors completed in-depth interviews about their care experiences and unmet needs, and the researchers analyzed the transcripts using framework analysis, a structured qualitative approach that organizes data into predefined and emergent themes. The interviews surfaced four consistent ways survivors believed digital services would enhance their care: facilitating communication with care teams, improving access to behavioral health support, enabling social support connections, and providing flexibility in choosing visit modality. For survivors juggling work, family obligations, and long drives to regional cancer centers, the ability to choose between a video visit and an in-person appointment was not a luxury but a practical necessity that could determine whether recommended follow-up happened at all.

The stakes of that flexibility become clear when set against the well-documented barriers rural cancer survivors face. Prior research cited by the authors documents transportation burdens as a major obstacle to cancer care delivery in rural populations, along with rural-urban disparities in financial hardship among survivors. Loss to follow-up is a chronic problem across oncology: survivors of breast, colorectal, head and neck, and hematopoietic cell transplantation all show elevated rates of falling out of guideline-recommended surveillance, and distance amplifies that risk. Survivorship care, the phase after curative treatment ends, is precisely when patients are most likely to drift away from the health system, even as they face long-term and late effects of their disease and its treatment. If digital services can keep rural survivors connected during this vulnerable window, the potential payoff in adherence to surveillance and management of late effects is considerable.

The study arrives at a moment when the policy architecture of survivorship care is being rebuilt. National standards for cancer survivorship care have recently been developed through a consensus process, and health systems are now being assessed against criteria that expect coordinated, patient-centered follow-up. The authors argue that systems capable of delivering integrated digital services supporting monitoring during survivorship will be best positioned to meet those standards while providing high-quality care to geographically dispersed patients. The Dartmouth findings suggest that the raw material for such integration, an engaged patient population already comfortable with portals and telehealth, exists even in rural settings. What remains is the harder work of designing digital survivorship programs that fit clinical workflows and patient preferences rather than simply porting in-person services onto a video platform.

The authors are careful about what their data cannot yet answer. Preferences for digital care delivery, they note, likely shift across the continuum of survivorship, from the early period after diagnosis through posttreatment transition and into long-term follow-up, and further research is needed to map those evolving priorities explicitly. They also point to an emerging frontier: as patients increasingly use digital tools for information seeking, decision-making, and personal health monitoring, the interface between consumer-generated health data and clinical records will demand new technical and organizational solutions. The broader literature on digital determinants of health and on digital navigation programs in safety-net systems suggests that structured support, such as digital health navigators who help patients set up and use virtual tools, may be one mechanism for ensuring that expanded digital offerings do not inadvertently widen inequities within rural populations.

What makes this study resonate beyond New Hampshire and Vermont is its challenge to a design assumption embedded in countless digital health initiatives: that rural equals disconnected. The evidence here, drawn from a large cohort, a stratified survey, and qualitative interviews, shows high engagement with telehealth and genuine appetite for digital survivorship programming among a population that is 80 percent rural. Behavioral health’s near-total shift to virtual delivery demonstrates that when telehealth removes a real barrier, patients use it enthusiastically. The absence of a link between measured digital readiness and actual engagement suggests that gatekeeping digital services by readiness scores may be misguided. For cancer centers serving rural regions, and for the national standards now shaping survivorship care, the message is that augmenting in-person services with well-designed digital programming is not a speculative bet on patient behavior. The patients, the data suggest, are already there.

Subject of Research: Digital health service use and survivorship care preferences among rural cancer survivors

Article Title: A mixed-methods study characterizing patient experiences with digital survivorship services and preferences for care at a rural cancer center

Article References: Gunn, C. M., Gallagher, L. G., Angelo, M. S., Purvis, L. A., Sykes, C., & Kuhn, E. S. (2026). A mixed-methods study characterizing patient experiences with digital survivorship services and preferences for care at a rural cancer center. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-026-02127-w

Image Credits: AI Generated

DOI: 10.1007/s11764-026-02127-w

Keywords: cancer survivorship, digital health, telehealth, rural health, patient portals, behavioral health, mixed methods, health care access, survivorship care standards, digital health readiness, oncology, health equity