title: Distance from treating hospital and colorectal cancer survivors' quality of life: a gendered analysis.
abstract: OBJECTIVE
  Distance from residence to hospital has been associated with clinical outcomes for colorectal cancer patients. However, little is known about the association of remoteness with quality of life (QoL) for colorectal cancer survivors. We examined the relationship between distance from hospital and colorectal cancer survivors' QoL, with a specific focus on gender.
  
  
  METHODS
  Colorectal cancer survivors in Ireland who were more than 6-months postdiagnosis completed the European Organization for Research and Treatment of Cancer QLQ-C30, measuring global health status (GHS) and physical, role, cognitive, social, and emotional functioning. Bootstrap linear regression was used to evaluate the association between remoteness and QoL scales, controlling for demographic and clinical variables. Separate models were generated for the full sample, for women, and for men.
  
  
  RESULTS
  The final analytical sample was 496 colorectal cancer survivors; 186 women and 310 men. Living remote from the treating hospital was associated with lower physical functioning (coefficient -4.38 [95 % confidence interval -8.13, -0.91]) and role functioning (coeff. -7.78 [-12.64, -2.66]) among all colorectal cancer survivors. In the separate gender models, remoteness was significantly associated with lower physical (coeff. -7.00 [-13.47, -1.49]) and role functioning (coeff. -11.50 [-19.66, -2.65]) for women, but not for men. Remoteness had a significant negative relationship to GHS (coeff. -4.31 [-8.46, -0.27]) for men.
  
  
  CONCLUSIONS
  Aspects of QoL are lower among colorectal cancer survivors who live far from their treating hospital. There are gender differences in how remoteness is related to QoL domains. The results of this study suggest that policy makers, service providers, and health care professionals should consider the specific QoL needs of remote colorectal cancer survivors, and be attuned to and prepared to address the differing needs of men and women.
authors.affiliation: Health Promotion Research Centre, National University of Ireland, Aras na Coiribe, Galway, Ireland, audrey.thomas@nuigalway.ie.
authors.forename: Audrey Alforque
authors.initials: AA
authors.lastname: Thomas
authors.forename: Pamela
authors.initials: P
authors.lastname: Gallagher
authors.forename: Alan
authors.initials: A
authors.lastname: O'Céilleachair
authors.forename: Alison
authors.initials: A
authors.lastname: Pearce
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
authors.forename: Michal
authors.initials: M
authors.lastname: Molcho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016522:Oncology Service, Hospital; D011788:Quality of Life; D012737:Sex Factors; D017741:Survivors / Q000523:psychology*