title: Urban-Rural Variations in Quality-of-Life in Breast Cancer Survivors Prescribed Endocrine Therapy.
abstract: The number of breast cancer survivors has increased as a result of rising incidence and increased survival. Research has revealed significant urban-rural variation in clinical aspects of breast cancer but evidence in the area of survivorship is limited. We aimed to investigate whether quality of life (QoL) and treatment-related symptoms vary between urban and rural breast cancer survivors prescribed endocrine therapy. Women with a diagnosis of stages I-III breast cancer prescribed endocrine therapy were identified from the National Cancer Registry Ireland and invited to complete a postal survey (N= 1606; response rate = 66%). A composite measure of urban-rural classification was created using settlement size, population density and proximity to treatment hospital. QoL was measured using the Functional Assessment of Cancer Therapy (FACT-G) and an endocrine subscale. The association between urban-rural residence/status and QoL and endocrine symptoms was assessed using linear regression with adjustment for socio-demographic and clinical covariates. In multivariable analysis, rural survivors had a statistically significant higher overall QoL (β = 3.81, standard error (SE) 1.30,p< 0.01), emotional QoL (β = 0.70, SE 0.21,p< 0.01) and experienced a lower symptom burden (β = 1.76, SE 0.65,p< 0.01) than urban survivors. QoL in breast cancer survivors is not simply about proximity and access to healthcare services but may include individual and community level psychosocial factors.
authors.affiliation: Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland. caitrionacahir@rcsi.ie.
authors.forename: Caitriona
authors.initials: C
authors.lastname: Cahir
authors.affiliation: Office of Planning & Analysis, University of California, Berkeley, CA 94720, USA. audrey@berkeley.edu.
authors.forename: Audrey Alforque
authors.initials: AA
authors.lastname: Thomas
authors.affiliation: Division of Psychology, University of Stirling, Stirling FK9 4LA, UK. s.u.dombrowski@stir.ac.uk.
authors.forename: Stephan U
authors.initials: SU
authors.lastname: Dombrowski
authors.affiliation: Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland. kathleenebennett@rcsi.ie.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle NE1 7RU, UK. Linda.Sharp@newcastle.ac.uk.
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D017024:Chemotherapy, Adjuvant; D004334:Drug Administration Schedule; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007494:Ireland; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control / Q000523:psychology; D011788:Quality of Life; D012111:Residence Characteristics; D012424:Rural Population / Q000706:statistics & numerical data*; D012944:Social Support; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data*; D044465:White People
chemical_list: D018931:Antineoplastic Agents, Hormonal
keywords: breast cancer; endocrine therapy; quality of life; rural; survivorship; urban