Cancer survivors are living longer, growing in number as the proportion of older adults in the population increases, and are now recognized as being at risk for decrements in health and well-being due to cancer and cancer treatment. Effects of treatment may persist many years after diagnosis and new treatment-related problems can appear years after treatment is completed. Challenges that confront survivors are not simply a continuation of experiences that occur during the cancer treatment phase; they are unique problems in the cancer illness trajectory, as the person treated for cancer transitions from the acute to the chronic phases of the illness. Persistent effects include physical and psychological symptoms and social and spiritual impact. Rural dwelling survivors are viewed as having higher levels of risk for decrements in health and well-being due to decreased access to healthcare, specialty services, and support resources. The purpose of this descriptive and mixed methods design study is to explore and compare the impact of cancer in rural and urban-dwelling adult cancer survivors in two regions of the Pacific Northwest, Alaska and Oregon.