Urban–Rural Variations in Quality-of-Life in Breast Cancer Survivors Prescribed Endocrine Therapy
by
Caitriona Cahir 1,*
, Audrey Alforque Thomas 2, Stephan U. Dombrowski 3, Kathleen Bennett 1 and Linda Sharp 4
Caitriona Cahir 1,*, Audrey Alforque Thomas 2, Stephan U. Dombrowski 3, Kathleen Bennett 1 and Linda Sharp 4
1
Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
2
Office of Planning & Analysis, University of California, Berkeley, CA 94720, USA
3
Division of Psychology, University of Stirling, Stirling FK9 4LA, UK
4
Institute of Health and Society, Newcastle University, Newcastle NE1 7RU, UK
*
Author to whom correspondence should be addressed.
Academic Editor: Peter Baade
Int. J. Environ. Res. Public Health 2017, 14(4), 394; https://doi.org/10.3390/ijerph14040394
Received: 27 February 2017 / Revised: 31 March 2017 / Accepted: 5 April 2017 / Published: 7 April 2017
(This article belongs to the Special Issue Geographical Variation in Breast Cancer Outcomes)
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.
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Keywords:
urban; rural; quality of life; breast cancer; survivorship; endocrine therapy
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
MDPI and ACS Style
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.
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