Anbari Allison B, Lee Knoo, Hulett Jennifer M, Micheas Lada, Ren Zewei, Belenchia Anthony, Lee Suhwon
Sinclair School of Nursing, University of Missouri, Columbia, MO, 65211, USA.
College of Arts and Sciences; Statistics, University of Missouri, Columbia, MO, 65211, USA.
BMC Health Serv Res. 2024 Dec 3;24(1):1533. doi: 10.1186/s12913-024-12014-8.
There are more than 4 million breast cancer survivors in the United States. With continuing improvements in early detection and treatment, the number of breast cancer survivors will only continue to increase. Breast cancer survivors face a lifetime risk of long-term or late-effects from cancer treatments, thus post-cancer treatment care, referred to as survivorship care, is critical. Social determinants of health, including where a breast cancer survivor lives, may impact cancer survivorship care. Our purpose was to evaluate the relationship between rural/urban status and receipt of cancer survivorship care and instructions for Missouri breast cancer survivors using state-level data from a nationwide telephone survey-the Behavioral Risk Factor Surveillance System (BRFSS).
Missouri included the BRFSS Cancer Survivorship Module in 2014, 2016, 2018, and 2020. Module items ask cancer survivors about receipt of a "post-cancer-treatment summary" and "follow-up instructions." We hypothesized chances of receipt of both components would differ among four level Rural-Urban Commuting Area (RUCA) Code groups (Rural, Small-Town, Micropolitan, Metropolitan). Data from 430 breast cancer survivors over four survey years were combined and grouped according to RUCA status. Using a logistic model with a multilevel approach (after sampling weights calibration), the relationship between receipt of survivorship instructions and RUCA group was examined.
46% of Missouri breast cancer survivors reported receipt of complete survivorship instructions. Compared to rural breast cancer survivors, micropolitan breast cancer survivors had 5.9 times higher odds of receiving survivorship instructions (p < 0.0001).
Less than half of respondents reported receiving complete post-cancer treatment instructions. More urban respondents were more likely to receive instructions than their rural counterparts which raises questions about the quality of post-treatment care between rural and urban survivors. A sophisticated and purposeful approach to mitigating potential disparities is warranted. Receipt of cancer survivorship care plans may be impacted by rurality/urbanicity. Clinicians caring for cancer survivors living in rural or urban settings must continue to be diligent with providing personalized survivorship care.
美国有超过400万乳腺癌幸存者。随着早期检测和治疗的不断改进，乳腺癌幸存者的数量只会持续增加。乳腺癌幸存者面临着癌症治疗带来的长期或晚期影响的终身风险，因此，癌症治疗后的护理，即生存护理，至关重要。健康的社会决定因素，包括乳腺癌幸存者的居住地点，可能会影响癌症生存护理。我们的目的是利用来自全国电话调查——行为风险因素监测系统（BRFSS）的州级数据，评估密苏里州乳腺癌幸存者的城乡状况与接受癌症生存护理及指导之间的关系。
密苏里州在2014年、2016年、2018年和2020年纳入了BRFSS癌症生存模块。模块项目询问癌症幸存者是否收到“癌症治疗后总结”和“后续指导”。我们假设在四个城乡通勤区域（RUCA）代码组（农村、小镇、微型都市、大都市）中，收到这两个部分的可能性会有所不同。将四个调查年份中430名乳腺癌幸存者的数据进行合并，并根据RUCA状况进行分组。使用经过多级抽样权重校准的逻辑模型，研究了接受生存指导与RUCA组之间的关系。
46%的密苏里州乳腺癌幸存者报告收到了完整的生存指导。与农村乳腺癌幸存者相比，微型都市乳腺癌幸存者收到生存指导的几率高5.9倍（p<0.0001）。
不到一半的受访者报告收到了完整的癌症治疗后指导。城市受访者比农村受访者更有可能收到指导，这引发了关于城乡幸存者治疗后护理质量的问题。有必要采取一种复杂且有针对性的方法来缓解潜在的差异。接受癌症生存护理计划可能会受到城乡差异的影响。照顾农村或城市癌症幸存者的临床医生必须继续努力提供个性化的生存护理。
