Cahir Caitriona, Thomas Audrey Alforque, Dombrowski Stephan U, Bennett Kathleen, Sharp Linda
Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
Office of Planning & Analysis, University of California, Berkeley, CA 94720, USA.
Int J Environ Res Public Health. 2017 Apr 7;14(4):394. doi: 10.3390/ijerph14040394.
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 ( = 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, < 0.01), emotional QoL (β = 0.70, SE 0.21, < 0.01) and experienced a lower symptom burden (β = 1.76, SE 0.65, < 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.
由于发病率上升和生存率提高，乳腺癌幸存者的数量有所增加。研究表明，乳腺癌的临床情况存在显著的城乡差异，但关于生存情况的证据有限。我们旨在调查接受内分泌治疗的城乡乳腺癌幸存者在生活质量（QoL）和治疗相关症状方面是否存在差异。从爱尔兰国家癌症登记处确定了诊断为I - III期乳腺癌且接受内分泌治疗的女性，并邀请她们完成一项邮寄调查（n = 1606；回复率 = 66%）。使用定居点规模、人口密度和与治疗医院的距离创建了城乡分类的综合指标。使用癌症治疗功能评估（FACT - G）和一个内分泌子量表来测量生活质量。使用线性回归评估城乡居住/状态与生活质量和内分泌症状之间的关联，并对社会人口统计学和临床协变量进行调整。在多变量分析中，农村幸存者的总体生活质量（β = 3.81，标准误差（SE）1.30，P < 0.01）、情感生活质量（β = 0.70，SE 0.21，P < 0.01）在统计学上显著高于城市幸存者，且症状负担更低（β = 1.76，SE 0.65，P < 0.01）。乳腺癌幸存者的生活质量不仅仅关乎与医疗服务的距离和可及性，还可能包括个人和社区层面的心理社会因素。
