Urban–Rural Variations in Quality-of-Life in Breast Cancer Survivors Prescribed Endocrine Therapy
Abstract
:1. Introduction
2. Methods
2.1. Study Population
2.2. Outcome Measures QoL
2.3. Urban–Rural Measure
2.4. Covariates
2.5. Statistical Analysis
3. Results
3.1. Study Population
3.2. QoL and Endocrine Symptoms
3.3. Multivariable Analysis: Associations between Urban–Rural Variation and QoL and Endocrine Symptoms
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
- Bray, F.; Ren, J.S.; Masuyer, E.; Ferlay, J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int. J. Cancer 2013, 132, 1133–1145. [Google Scholar] [CrossRef] [PubMed]
- National Cancer Registry Ireland. Cancer in Ireland 1994–2013: Annual Report of the National Cancer Registry; National Cancer Registry Ireland: Cork, Ireland, 2015. [Google Scholar]
- Allemani, C.; Weir, H.K.; Carreira, H.; Harewood, R.; Spika, D.; Wang, X.S.; Bannon, F.; Ahn, J.V.; Johnson, C.J.; Bonaventure, A.; et al. Global surveillance of cancer survival 1995–2009: Analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 2015, 385, 977–1010. [Google Scholar] [CrossRef]
- De Angelis, R.; Sant, M.; Coleman, M.P.; Francisci, S.; Baili, P.; Pierannunzio, D.; Trama, A.; Visser, O.; Brenner, H.; Ardanaz, E.; et al. Cancer survival in Europe 1999–2007 by country and age: Results of EUROCARE-5—A population-based study. Lancet Oncol. 2014, 15, 23–34. [Google Scholar] [CrossRef]
- Maher, J.; McConnell, H. New pathways of care for cancer survivors: Adding the numbers. Br. J. Cancer 2011, 105 (Suppl. 1), S5–S10. [Google Scholar] [CrossRef] [PubMed]
- Hewitt, M.; Greenfield, S.; Stovall, E. From Cancer Patient to Cancer Survivor: Lost in Transition; Institute of Medicine and National Research Council; The National Academic Press: Washington, DC, USA, 2005. [Google Scholar]
- Davies, C.; Godwin, J.; Gray, R.; Clarke, M.; Cutter, D.; Darby, S.; McGale, P.; Pan, H.C.; Taylor, C.; Wang, Y.C.; et al. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: Patient-level meta-analysis of randomised trials. Lancet 2011, 378, 771–784. [Google Scholar] [PubMed]
- Anderson, W.F.; Chatterjee, N.; Ershler, W.B.; Brawley, O.W. Estrogen receptor breast cancer phenotypes in the Surveillance, Epidemiology, and End Results database. Breast Cancer Res Treat. 2002, 76, 27–36. [Google Scholar] [CrossRef] [PubMed]
- Cella, D.; Fallowfield, L.; Barker, P.; Cuzick, J.; Locker, G.; Howell, A. Quality of life of postmenopausal women in the ATAC (“Arimidex”, tamoxifen, alone or in combination) trial after completion of 5 years’ adjuvant treatment for early breast cancer. Breast Cancer Res Treat. 2006, 100, 273–284. [Google Scholar] [CrossRef] [PubMed]
- Lintermans, A.; Neven, P. Safety of aromatase inhibitor therapy in breast cancer. Expert Opin. Drug Saf. 2015, 14, 1201–1211. [Google Scholar] [CrossRef] [PubMed]
- Kool, M.; Fontein, D.B.; Meershoek-Klein Kranenbarg, E.; Nortier, J.W.; Rutgers, E.J.; Marang-van de Mheen, P.J.; van de Velde, C.J. Long term effects of extended adjuvant endocrine therapy on quality of life in breast cancer patients. Breast 2015, 24, 224–229. [Google Scholar] [CrossRef] [PubMed]
- DiSipio, T.; Hayes, S.C.; Newman, B.; Aitken, J.; Janda, M. Does quality of life among breast cancer survivors one year after diagnosis differ depending on urban and non-urban residence? A comparative study. Health Qual. Life Outcomes 2010, 8, 3. [Google Scholar] [CrossRef] [PubMed]
- Rowland, J.H.; Kent, E.E.; Forsythe, L.P.; Loge, J.H.; Hjorth, L.; Glaser, A.; Mattioli, V.; Fosså, S.D. Cancer survivorship research in Europe and the United States: where have we been, where are we going, and what can we learn from each other? Cancer 2013, 119 (Suppl. 11), 2094–2108. [Google Scholar] [CrossRef] [PubMed]
- Markossian, T.W.; Hines, R.B. Disparities in late stage diagnosis, treatment, and breast cancer-related death by race, age, and rural residence among women in Georgia. Women Health 2012, 52, 317–335. [Google Scholar] [CrossRef] [PubMed]
- Nguyen-Pham, S.; Leung, J.; McLaughlin, D. Disparities in breast cancer stage at diagnosis in urban and rural adult women: A systematic review and meta-analysis. Ann. Epidemiol. 2014, 24, 228–235. [Google Scholar] [CrossRef] [PubMed]
- Nennecke, A.; Geiss, K.; Hentschel, S.; Vettorazzi, E.; Jansen, L.; Eberle, A.; Holleczek, B.; Gondos, A.; Brenner, H. GEKID Cancer Survival Working Group. Survival of cancer patients in urban and rural areas of Germany—A comparison. Cancer Epidemiol. 2014, 38, 259–265. [Google Scholar] [CrossRef] [PubMed]
- Reid-Arndt, S.A.; Cox, C.R. Does rurality affect quality of life following treatment for breast cancer? J. Rural Health 2010, 26, 402–405. [Google Scholar] [CrossRef] [PubMed]
- Waldmann, A.; Pritzkuleit, R.; Raspe, H.; Katalinic, A. The OVIS study: Health related quality of life measured by the EORTC QLQ-C30 and -BR23 in German female patients with breast cancer from Schleswig-Holstein. Qual. Life Res. 2007, 16, 767–776. [Google Scholar] [CrossRef] [PubMed]
- Pacian, A.; Kulik, T.B.; Pacian, J.; Chrusciel, P.; Zolnierczuk-Kieliszek, D.; Jarosz, M.J. Psychosocial aspect of quality of life of Polish women with breast cancer. Ann. Agric. Environ. Med. 2012, 19, 509–512. [Google Scholar] [PubMed]
- Jefford, M.; Rowland, J.; Grunfeld, E.; Richards, M.; Maher, J.; Glaser, A. Implementing improved post-treatment care for cancer survivors in England, with reflections from Australia, Canada and the USA. Br. J. Cancer 2013, 108, 14–20. [Google Scholar] [CrossRef] [PubMed]
- Cahir, C.; Sharp, L.; O’Connor, J.; Dombrowski, S.U.; Bennett, K. Identifying the modifiable determinants of endocrine therapy medication taking behaviour in women with stages I–III breast cancer. Breast Cancer Res. Treat. 2017. (submitted). [Google Scholar]
- National Cancer Registry Ireland. Data Quality and Completeness at the Irish National Cancer Registry (Technical Report); National Cancer Registry Ireland: Cork, Ireland, 2012. [Google Scholar]
- Cella, D.F.; Tulsky, D.S.; Gray, G.; Sarafian, B.; Linn, E.; Bonomi, A.; Silberman, M.; Yellen, S.B.; Winicour, P.; Brannon, J.; et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J. Clin. Oncol. 1993, 11, 570–579. [Google Scholar] [CrossRef] [PubMed]
- Cella, D.; Hernandez, L.; Bonomi, A.E.; Corona, M.; Vaquero, M.; Shiomoto, G.; Baez, L. Spanish language translation and initial validation of the functional assessment of cancer therapy quality-of-life instrument. Med. Care. 1998, 36, 1407–1418. [Google Scholar] [CrossRef] [PubMed]
- Dapueto, J.J.; Francolino, C.; Servente, L.; Chang, C.-H.; Gotta, I.; Levin, R.; del Carmen Abreu, M. Evaluation of the Functional Assessment of Cancer Therapy-General (FACT-G) Spanish version 4 in South America: Classic psychometric and item response theory analyses. Health Qual. Life Outcomes 2003, 1, 32. [Google Scholar] [CrossRef] [PubMed]
- Winstead-Fry, P.; Schultz, A. Psychometric analysis of the Functional Assessment of Cancer Therapy-General (FACT-G) scale in a rural sample. Cancer 1997, 79, 2446–2452. [Google Scholar] [CrossRef]
- Fumimoto, H.; Kobayashi, K.; Chang, C.H.; Eremenco, S.; Fujiki, Y.; Uemura, S.; Ohashi, Y.; Kudoh, S. Cross-cultural validation of an international questionnaire, the General Measure of the Functional Assessment of Cancer Therapy scale (FACT-G), for Japanese. Qual. Life Res. 2001, 10, 701–709. [Google Scholar] [CrossRef] [PubMed]
- FACIT. Functional Assessment of Chronic Illness Therapy (FACIT) Questionnaires. Available online: http://www.factit.org/FACITOrg/Questionnaires (accessed on 21 February 2017).
- Fallowfield, L.J.; Leaity, S.K.; Howell, A.; Benson, S.; Cella, D. Assessment of quality of life in women undergoing hormonal therapy for breast cancer: Validation of an endocrine symptom subscale for the FACT-B. Breast Cancer Res. Treat. 1999, 55, 189–199. [Google Scholar] [CrossRef] [PubMed]
- Sert, F.; Ozsaran, Z.; Eser, E.; Alanyali, S.D.; Haydaroglu, A.; Aras, A. Quality of life assessment in women with breast cancer: A prospective study including hormonal therapy. J. Breast Cancer 2013, 16, 220–228. [Google Scholar] [CrossRef] [PubMed]
- Teljeur, C.; Kelly, A. An urban–rural classification for health services research in Ireland. Ir. Geogr. 2008, 41, 295–311. [Google Scholar] [CrossRef]
- Thomas, A.A.; Timmons, A.; Molcho, M.; Pearce, A.; Gallagher, P.; Butow, P.; O’Sullivan, E.; Gooberman-Hill, R.; O’Neill, C.; Sharp, L. Quality of life in urban and rural settings: A study of head and neck cancer survivors. Oral Oncol. 2014, 50, 676–682. [Google Scholar] [CrossRef] [PubMed]
- Ireland Central Statistics Office. This Is Ireland: Highlights from Census 2011, Part 1; Stationary Office: Dublin, Ireland, 2012.
- Sharp, L.; Donnelly, D.; Hegarty, A.; Carsin, A.E.; Deady, S.; McCluskey, N.; Gavin, A.; Comber, H. Risk of several cancers is higher in urban areas after adjusting for socioeconomic status. Results from a two-country population-based study of 18 common cancers. J. Urban Health 2014, 91, 510–525. [Google Scholar] [CrossRef] [PubMed]
- Mols, F.; Vingerhoets, A.; Coebergh, J.; van de Poll-Franse, L. Quality of life among long-term breast cancer survivors: A systematic review. Eur. J. Cancer 2005, 41, 2613–2619. [Google Scholar] [CrossRef] [PubMed]
- Haase and Pratschke. Pobal HP Deprivation Index for Small Areas 2012. Available online: http://trutzhaase.eu/deprivation-index/the-2011-all-island-hp-deprivation-index (accessed on 3 February 2017).
- Health Service Executive. Primary Care Reimbursement Service: Statistical Analysis of Claims and Payments 2014. Available online: http://www.pcrs.ie/ (accessed on 8 February 2017).
- Cameron, A.C.; Trivedi, P.K. Microeconometrics Using Stata; College Stata Press: College Station, TX, USA, 2009. [Google Scholar]
- Webster, K.; Cella, D.; Yost, K. The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: Properties, applications, and interpretation. Health Qual. Life Outcomes 2003, 1, 1–7. [Google Scholar] [CrossRef] [PubMed]
- Guyatt, G.H.; Osoba, D.; Wu, A.W.; Wyrwich, K.W.; Norman, G.R. Methods to explain the clinical significance of health status measures. Mayo Clin. Proc. 2002, 77, 371–383. [Google Scholar] [CrossRef] [PubMed]
- Butow, P.N.; Phillips, F.; Schweder, J.; White, K.; Underhill, C.; Goldstein, D. Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: A systematic review. Suppl. Care Cancer 2012, 20, 1–22. [Google Scholar] [CrossRef] [PubMed]
- Van Lente, E.; Barry, M.M.; Molcho, M.; Morgan, K.; Watson, D.; Harrington, J.; McGee, H. Measuring population mental health and social well-being. Int. J. Public Health Res. 2012, 57, 421–430. [Google Scholar] [CrossRef] [PubMed]
- Schultz, A.; Winstead-Fry, P. Predictors of quality of life in rural patients with cancer. Cancer Nurs. 2001, 24, 12–19. [Google Scholar] [CrossRef] [PubMed]
- Schlegel, R.J.; Talley, A.E.; Molix, L.A.; Bettencourt, B.A. Rural breast cancer patients, coping and depressive symptoms: a prospective comparison study. Psychol. Health 2009, 24, 933–948. [Google Scholar] [CrossRef] [PubMed]
- Bettencourt, B.A.; Talley, A.E.; Molix, L.; Schlegel, R.; Westgate, S.J. Rural and urban breast cancer patients: Health locus of control and psychological adjustment. Psychooncology 2008, 17, 932–939. [Google Scholar] [CrossRef] [PubMed]
- Wilson, S.E.; Andersen, M.R.; Meischke, H. Meeting the needs of rural breast cancer survivors: What still needs to be done? J. Women’s Health Gend. Based Med. 2000, 9, 667–977. [Google Scholar] [CrossRef] [PubMed]
- Kroneman, M.; Verheij, R.; Tacken, M.; van der Zee, J. Urban–rural health differences: Primary care data and self-reported data render different results. Health Place 2010, 16, 893–902. [Google Scholar] [CrossRef] [PubMed]
- Bain, N.S.C.; Campbell, N.C. Treating patients with colorectal cancer in rural and urban areas: A qualitative study of the patients’ perspective. Fam. Pract. 2000, 17, 475–479. [Google Scholar] [CrossRef] [PubMed]
- Kroenke, C.H.; Kubzansky, L.D.; Schernhammer, E.S.; Holmes, M.D.; Kawachi, I. Social networks, social support, and survival after breast cancer diagnosis. J. Clin. Oncol. 2006, 24, 1105–1111. [Google Scholar] [CrossRef] [PubMed]
- Central Statistics Office. Community Involvement and Social Networks. 2006. Available online: http://www.cso.ie/en/media/csoie/releasespublications/documents/labourmarket/2006/comsoc06.pdf (accessed on 9 February 2017).
- Barry, M.M.; Van Lente, E.; Molcho, M.; Morgan, K.; McGee, H.; Conroy, R.M.; Watson, D.; Shelley, E.; Perry, I. SLAN 2007: Survey of Lifestyle, Attitudes and Nutrition in Ireland. Mental Health and Social Well-Being Report; Department of Health and Children: Dublin, Ireland, 2009.
- O’Brien, K.M.; Timmons, A.; Butow, P.; Gooberman-Hill, R.; O’Sullivan, E.; Balfe, M.; Sharp, L. Associations between neighbourhood support and financial burden with unmet needs of head and neck cancer survivors. Oral Oncol. 2017, 65, 57–64. [Google Scholar] [CrossRef] [PubMed]
- Teljeur, C.; O’Dowd, D.; Thomas, S.; Kelly, A. The distribution of GPs in Ireland in relation to deprivation. Health Place 2010, 16, 1077–1083. [Google Scholar] [CrossRef] [PubMed]
- Rogers-Clark, C. Living with breast cancer: The influence of rurality on women’s suffering and resilience. A postmodern feminist inquiry. Aust. J. Adv. Nurs. 2002, 20, 34–39. [Google Scholar] [PubMed]
- Ganz, P.A.; Desmond, K.A.; Leedham, B.; Rowland, J.H.; Meyerowitz, B.E.; Belin, T.R. Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study. J. Natl. Cancer Inst. 2002, 94, 39–49. [Google Scholar] [CrossRef] [PubMed]
- Crivellari, D.; Bonetti, M.; Castiglione-Gertsch, M.; Gelber, R.D.; Rudenstam, C.-M.; Thürlimann, B.; Price, K.N.; Coates, AS.; Hürny, C.; Bernhard, J.; et al. Burdens and benefits of adjuvant cyclophosphamide, methotrexate, and fluorouracil and tamoxifen for elderly patients with breast cancer: The International Breast Cancer Study Group Trial VII. J. Clin. Oncol. 2000, 18, 1412–1422. [Google Scholar] [CrossRef] [PubMed]
- Cahir, C.; Guinan, E.; Dombrowski, S.U.; Sharp, L.; Bennett, K. Identifying the determinants of adjuvant hormonal therapy medication taking behaviour in women with stages I–III breast cancer: A systematic review and meta-analysis. Patient Educ. Counsel. 2015, 98, 1524–1539. [Google Scholar] [CrossRef] [PubMed]
- Murphy, C.C.; Bartholomew, L.K.; Carpentier, M.Y.; Bluethmann, S.M.; Vernon, S.W. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: A systematic review. Breast Cancer Res. Treat. 2012, 134, 459–478. [Google Scholar] [CrossRef] [PubMed]
Urban (N = 870) | Rural (N = 698) | p-Value a | |
---|---|---|---|
N (%) | N (%) | ||
Socio-demographics | |||
Age—mean (SD) | 60.4 (10.3) | 59.7 (10.1) | p = 0.17 |
Marital status | |||
Not in a relationship | 266 (30.7) | 152 (21.8) | p < 0.01 * |
Married/long-term relationship b | 599 (69.3) | 545 (78.2) | |
Education | |||
Primary | 110 (12.8) | 95 (13.7) | p = 0.74 |
Secondary | 362 (42.1) | 279 (40.3) | |
Third level or post-graduate | 388 (45.1) | 318 (46.0) | |
Occupational status | |||
Employed (employee/self-employed) | 313 (36.4) | 271 (39.0) | p = 0.08 |
Looking after family/home | 168 (19.6) | 165 (23.7) | |
Retired from employment | 248 (28.9) | 169 (24.3) | |
Unable to work (sickness/disability) | 86 (10.0) | 63 (9.1) | |
Other c | 44 (5.1) | 27 (3.9) | |
Deprivation | |||
1 (least deprived) | 205 (23.6) | 62 (8.9) | p < 0.01 * |
2 | 196 (22.5) | 152 (21.8) | |
3 | 143 (16.4) | 197 (28.2) | |
4 | 157 (18.1) | 180 (25.8) | |
5 (most deprived) | 169 (19.4) | 107 (15.3) | |
Smoking status at diagnosis | |||
Current | 124 (14.5) | 100 (14.6) | p < 0.05* |
Former | 145 (16.9) | 78 (11.3) | |
Never | 460 (53.7) | 400 (58.2) | |
Unknown | 128 (14.9) | 109 (15.9) | |
Medical card d | |||
Yes | 276 (32.0) | 288 (32.7) | p = 0.09 |
No | 587 (68.0) | 469 (67.3) | |
Clinical | |||
Chemotherapy and/or Radiotherapy | |||
Chemotherapy only | 82 (9.4) | 66 (9.5) | p = 0.25 |
Radiotherapy only | 330 (37.9) | 252 (36.1) | |
Chemotherapy and radiotherapy | 372 (42.8) | 327 (46.9) | |
No chemotherapy or radiotherapy | 86 (9.9) | 53 (7.6) |
All Participants | Urban (N = 870) | Rural (N = 698) | Urban–Rural Comparison | |||||||
---|---|---|---|---|---|---|---|---|---|---|
QoL | Median | IQR | N | Median | IQR | N | Median | IQR | z-Score | p-Value |
Overall QoL (FACT-ES) | 124 | 106–140 | 804 | 123 | 104–138 | 646 | 126 | 107–143 | −2.69 | <0.01 * |
Physical domain | 24 | 21–27 | 845 | 24 | 20–27 | 681 | 25 | 21–27 | −2.10 | <0.05 * |
Social domain | 22 | 17–26 | 844 | 22 | 17–26 | 677 | 22 | 17–26 | −0.56 | 0.58 |
Emotional domain | 20 | 17–23 | 838 | 20 | 17–22 | 671 | 20 | 18–23 | −3.57 | <0.01 * |
Functional domain | 21 | 17–26 | 843 | 21 | 17–25 | 672 | 22 | 18–26 | −3.17 | <0.01 * |
Endocrine symptoms | 40 | 29–48 | 845 | 39 | 29–47 | 681 | 41 | 30–49 | −1.90 | 0.06 |
Overall QoL (FACT-ES) | Physical | Social | Emotional | Functional | Endocrine Symptoms | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Unadjusted β (SE) | Adjusted β (SE) | Unadjusted β (SE) | Adjusted β (SE) | Unadjusted β (SE) | Adjusted β (SE) | Unadjusted β (SE) | Adjusted β (SE) | Unadjusted β (SE) | Adjusted β (SE) | Unadjusted β (SE) | Adjusted β (SE) | |
Urban–rural Rural (vs. urban) | 3.85 (1.36) * | 3.81 (1.30) * | 0.48 (0.25) * | 0.36 (0.24) | 0.25 (0.33) | 0.11 (0.35) | 0.76 (0.20) * | 0.70 (0.21) * | 0.81 (0.32) * | 0.53 (0.32) | 1.37 (0.70) * | 1.76 (0.65) * |
Socio-demographic Age (at survey completion- continuous) | 0.70 (0.06) | 0.59 (0.09) * | 0.07 (0.01) * | 0.06 (0.02) * | 0.05 (0.02) * | 0.06 (0.02) * | 0.07 (0.01) * | 0.05 (0.01) * | 0.01 (0.02) | 0.03 (0.02) | 0.49 (0.03) * | 0.40 (0.05) * |
Marital status (vs. no relationship) b | ||||||||||||
Married/long-term relationship | −1.61 (1.54) | 0.10 (1.53) | −0.17 (0.27) | −0.11 (0.28) | 1.36 (0.39) * | 1.59 (0.42) * | −0.22 (0.23) | −0.06 (0.24) | 1.30 (0.37) * | 1.06 (0.39) * | −4.73 (0.77) * | −2.73 (0.76) * |
Education (vs. primary) | ||||||||||||
Secondary | −3.79 (2.16) | −0.36 (2.23) | 0.18 (0.37) | 0.24 (0.41) | −0.80 (0.53) | −0.61 (0.57) | −0.26 (0.33) | 0.05 (0.36) | 0.56 (0.54) | 0.04 (0.57) | −2.95 (1.09) * | −0.12 (1.11) |
Third level or post-graduate | −6.07 (2.13) * | −1.55 (2.44) | −0.66 (0.37) | −0.60 (0.46) | −0.83 (0.51) | −0.47 (0.60) | −0.56 (0.32) | −0.11 (0.38) | 1.16 (0.52) * | 0.32 (0.60) | −4.89 (1.08) * | −1.00 (1.23) |
Occupational status (vs. employed) | ||||||||||||
Looking after family/home | 5.84 (1.70) * | 1.16 (1.88) | 0.71 (0.29) * | 0.09 (0.33) | 0.57 (0.44) | 0.02 (0.49) | 0.46 (0.26) | 0.02 (0.30) | −0.05 (0.39) | 0.11 (0.41) | 4.55 (0.88) * | 1.09 (0.97) |
Retired from employment | 9.71 (1.60) * | 0.99 (1.99) | 0.64 (0.27) * | −0.23 (0.35) | 0.72 (0.41) | 0.02 (0.55) | 1.09 (0.24) * | 0.26 (0.32) | −0.46 (0.39) | −0.23 (0.49) | 7.57 (0.83) * | 0.52 (1.01) |
Unable to work (sickness or disability) | −23.24 (2.24) * | −22.44 (2.66) * | −5.04 (0.54) | −4.97 (0.55) * | −1.09 (0.57) | −1.08 (0.61) | −2.32 (0.42) | −2.17 (0.43) * | −6.16 (0.52) * | −5.43 (0.57) * | −8.44 (1.17) * | −8.88 (1.31) * |
Other c | −6.48 (3.11) * | −6.34 (3.41) | −0.92 (0.61) | −0.94 (0.64) | 0.96 (0.95) | −1.26 (0.96) | −1.18 (0.56) * | −1.20 (0.54) * | −2.34 (0.82) * | −1.71 (0.87) * | −1.24 (1.59) | −1.11 (1.74) |
Deprivation (vs. least deprived) | ||||||||||||
2 | 1.84 (2.16) | 0.70 (2.04) | 0.79 (0.41) | 0.62 (0.38) | −0.52 (0.53) | −0.53 (0.53) | 0.05 (0.34) | 0.01 (0.33) | 0.32 (0.51) | 0.45 (0.49) | 1.51 (1.08) | 0.69 (1.02) |
3 | −0.17 (2.18) | −0.93 (2.16) | 0.31 (0.42) | 0.25 (0.40) | −0.39 (0.53) | −0.34 (0.55) | 0.31 (0.35) | 0.25 (0.34) | −0.01 (0.53) | 0.24 (0.52) | −0.15 (1.13) | −0.82 (1.07) |
4 | 0.60 (2.19) | −0.37 (2.12) | 0.44 (0.41) | 0.31 (0.40) | −0.26 (0.53) | −0.29 (0.56) | 0.16 (0.34) | 0.07 (0.34) | 0.38 (0.51) | 0.71 (0.51) | 0.41 (1.12) | −0.52 (1.07) |
5 | −1.10 (2.29) | −0.34 (2.26) | −0.29 (0.45) | −0.21 (0.45) | 0.12 (0.55) | 0.38 (0.58) | −0.04 (0.37) | 0.16 (0.37) | −0.33 (0.55) | 0.50 (0.55) | −0.19 (1.20) | −0.90 (1.14) |
Smoking status (vs. current) | ||||||||||||
Former | 4.72 (2.96) | 1.26 (2.59) | 1.02 (0.49) * | 0.55 (0.48) | 0.15 (0.63) | −0.21 (0.65) | 0.40 (0.42) | 0.02 (0.42) | 0.77 (0.58) | 0.20 (0.58) | 5.67 (1.12) * | 3.08 (1.00) * |
Never | 9.60 (1.96) * | 4.82 (2.00) * | 1.42 (0.40) * | 0.71 (0.37) | 0.77 (0.50) | 0.48 (0.52) | 1.09 (0.34) * | 0.63 (0.34) | 1.35 (0.47) * | 0.38 (0.48) | 2.99 (1.37) * | 1.26 (1.29) |
Unknown | 7.50 (2.46) * | 3.99 (2.38) | 1.19 (0.48) * | 0.74 (0.45) | 0.19 (0.64) | −0.03 (0.66) | 1.05 (0.41) * | 0.71 (0.41) | 0.90 (0.59) | 0.34 (0.58) | 4.80 (1.34) * | 2.62 (1.18) |
Medical card (vs. Yes) | ||||||||||||
No d | 0.47 (1.45) | 2.50 (1.58) | 0.43 (0.27) | 0.45 (0.30) | 0.14 (0.36) | 0.12 (0.42) | 0.31 (0.32) | 0.56 (0.26) * | 1.92 (0.35) * | 1.34 (0.39) * | −2.64 (0.74) * | −0.04 (0.79) |
Clinical Chemotherapy and/or radiotherapy (vs. none) | ||||||||||||
Chemotherapy only | −5.10 (3.06) | 0.33 (3.24) | −1.08 (0.55) * | −0.30 (0.58) | 0.74 (0.75) | 1.13 (0.83) | −0.84 (0.46) | −0.39 (0.52) | 0.28 (0.71) | 0.98 (0.78) | −3.06 (1.58) * | 0.05 (1.57) |
Radiotherapy only | 5.20 (2.43) * | 4.96 (2.53) * | 0.48 (0.44) | 0.48 (0.43) | 1.58 (0.60) * | 1.49 (0.69) * | 0.78 (0.37) * | 0.79 (0.41) | 1.41 (0.57) * | 1.53 (0.66) * | 1.20 (1.26) | 0.97 (1.22) |
Chemotherapy and radiotherapy | −0.83 (2.38) | 3.88 (2.57) | −0.32 (0.43) | 0.37 (0.45) | 1.51 (0.59) * | 1.67 (0.68) * | −0.41 (0.36) | 0.04 (0.42) | 0.66 (0.56) | 0.97 (0.64) | −2.26 (1.24) | 1.15 (1.26) |
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Cahir, C.; Thomas, A.A.; Dombrowski, S.U.; Bennett, K.; Sharp, L. Urban–Rural Variations in Quality-of-Life in Breast Cancer Survivors Prescribed Endocrine Therapy. Int. J. Environ. Res. Public Health 2017, 14, 394. https://doi.org/10.3390/ijerph14040394
Cahir C, Thomas AA, Dombrowski SU, Bennett K, Sharp L. Urban–Rural Variations in Quality-of-Life in Breast Cancer Survivors Prescribed Endocrine Therapy. International Journal of Environmental Research and Public Health. 2017; 14(4):394. https://doi.org/10.3390/ijerph14040394
Chicago/Turabian StyleCahir, Caitriona, Audrey Alforque Thomas, Stephan U. Dombrowski, Kathleen Bennett, and Linda Sharp. 2017. "Urban–Rural Variations in Quality-of-Life in Breast Cancer Survivors Prescribed Endocrine Therapy" International Journal of Environmental Research and Public Health 14, no. 4: 394. https://doi.org/10.3390/ijerph14040394