title: Quality of life in urban and rural settings: a study of head and neck cancer survivors.
abstract: OBJECTIVE
  Urban-rural variation in cancer incidence, treatment, and clinical outcomes has been well researched. With the growing numbers and longer lifespan of cancer survivors, quality of life (QOL) is now a critical issue. The present study investigates the QOL of head and neck cancer (HNC) survivors in Ireland, paying special attention to urban and rural variation.
  
  
  METHODS
  From the population-based National Cancer Registry Ireland, we identified 991 survivors of HNC (ICD10 C00-C14, C32), who were at least eight months post-diagnosis, and invited them to complete a postal survey. We used self-reported data and information from the Registry to create a composite variable classifying respondents' current area of residence as "urban" or "rural." Respondents self-reported QOL using the Functional Assessment for Cancer Therapy with Head and Neck module (FACT-HN). We used bootstrap linear regression to control for confounding variables, while estimating the association of urban and rural residence to FACT-HN domain scores.
  
  
  RESULTS
  We obtained survey and Registry data from 583 HNC survivors. Controlling for demographic and clinical variables, rural survivors reported higher physical (coefficient 1.27, bias-corrected and accelerated 95% confidence interval 0.54, 2.43), emotional (coef. 0.99, 95% CI 0.21, 2.02), and HNC-specific (coef. 1.55, 95% CI 0.32, 3.54) QOL than their urban counterparts. Social and functional QOL did not differ significantly.
  
  
  CONCLUSIONS
  These findings add to growing evidence of important differences in life experiences of cancers survivors in urban and rural settings. Results such as these will allow health professionals, policy makers and service providers to better serve these populations.
authors.affiliation: Health Promotion Research Centre, Aras na Coiribe, National University of Ireland, Galway, Ireland. Electronic address: audrey.thomas@nuigalway.ie.
authors.forename: Audrey Alforque
authors.initials: AA
authors.lastname: Thomas
authors.affiliation: National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland.
authors.forename: Aileen
authors.initials: A
authors.lastname: Timmons
authors.affiliation: National University of Ireland, School of Health Sciences, Galway, Ireland.
authors.forename: Michal
authors.initials: M
authors.lastname: Molcho
authors.affiliation: National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland.
authors.forename: Alison
authors.initials: A
authors.lastname: Pearce
authors.affiliation: School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland.
authors.forename: Pamela
authors.initials: P
authors.lastname: Gallagher
authors.affiliation: Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Butow
authors.affiliation: Cork University Dental School and Hospital, Wilton, Co. Cork, Ireland.
authors.forename: Eleanor
authors.initials: E
authors.lastname: O'Sullivan
authors.affiliation: School of Clinical Sciences, University of Bristol, Southmead Hospital BS10 5NB, United Kingdom.
authors.forename: Rachael
authors.initials: R
authors.lastname: Gooberman-Hill
authors.affiliation: School of Business and Economics, National University of Ireland, Galway, Ireland.
authors.forename: Ciaran
authors.initials: C
authors.lastname: O'Neill
authors.affiliation: National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland.
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012423:Rural Health; D057566:Self Report; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014504:Urban Health
keywords: Head and neck cancer; Ireland; Quality of life; Rural health; Survivorship; Urban