Rural living as context: a study of disparities in long-term cancer survivors.

PURPOSE/OBJECTIVES: To explore the impact of rurality on health-related quality-of-life (HRQOL) disparities in rural long-term cancer survivors.

DESIGN

Cross-sectional survey.

SETTING

Rural-Urban Continuum Codes (RUCC) 7, 8, and 9.

SAMPLE

91 adults at least five years post-treatment.

METHODS

Mailed surveys measured HRQOL, self-esteem, and social support. Regression models were estimated to isolate (from self-esteem and social support) the effect of level of rurality on HRQOL.

MAIN RESEARCH VARIABLES

HRQOL, self-esteem, social support, and rurality.

FINDINGS

No differences in demographic characteristics existed among RUCCs. Survivors residing in RUCCs 7 or 8 tended to be similar in several dimensions of HRQOL. Survivors living in RUCC 7 reported significantly lower social function and greater financial difficulty and number of symptoms compared to survivors in RUCC 9 (the most remote). Self-esteem and social support strongly correlated with HRQOL.

CONCLUSIONS

The significant impact of rurality on HRQOL beyond self-esteem and social support suggests its role in explaining cancer survivorship disparities and directing practice. Until additional exploration can identify mechanisms behind rurality's impact, consideration of level of rurality as a potential factor in evaluating survivors' HRQOL outcomes is reasonable.

IMPLICATIONS FOR NURSING

Survivor context (e.g., level of rurality) influences HRQOL outcomes. Context or culture-relevant risk minimization and HRQOL optimization nursing practices are indicated.