Rural living as context: a study of disparities in long-term cancer survivors.
OBJECTIVE
To explore the impact of rurality on health-related quality-of-life (HRQOL) disparities in rural long-term cancer survivors.


METHODS
Cross-sectional survey.


METHODS
Rural-Urban Continuum Codes (RUCC) 7, 8, and 9.


METHODS
91 adults at least five years post-treatment.


METHODS
Mailed surveys measured HRQOL, self-esteem, and social support. Regression models were estimated to isolate (from self-esteem and social support) the effect of level of rurality on HRQOL.


METHODS
HRQOL, self-esteem, social support, and rurality.


RESULTS
No differences in demographic characteristics existed among RUCCs. Survivors residing in RUCCs 7 or 8 tended to be similar in several dimensions of HRQOL. Survivors living in RUCC 7 reported significantly lower social function and greater financial difficulty and number of symptoms compared to survivors in RUCC 9 (the most remote). Self-esteem and social support strongly correlated with HRQOL.


CONCLUSIONS
The significant impact of rurality on HRQOL beyond self-esteem and social support suggests its role in explaining cancer survivorship disparities and directing practice. Until additional exploration can identify mechanisms behind rurality's impact, consideration of level of rurality as a potential factor in evaluating survivors' HRQOL outcomes is reasonable.


CONCLUSIONS
Survivor context (e.g., level of rurality) influences HRQOL outcomes. Context or culture-relevant risk minimization and HRQOL optimization nursing practices are indicated.
College of Nursing, University of Colorado in Denver.
Leli W
LW
Pedro
Department of Biostatistics and Informatics, University of Colorado in Denver.
Sarah J
SJ
Schmiege
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003120:Colorado; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D011788:Quality of Life; D019035:Rural Health Services; D012424:Rural Population / Q000706:statistics & numerical data*; D012649:Self Concept; D012944:Social Support; D017741:Survivors / Q000706:statistics & numerical data*
care of the medically underserved; health policy; quality of life; rural issues; survivorship