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.