1
|
Latham S, Leach MJ, White VM, Webber K, Jefford M, Lisy K, Davis N, Millar JL, Evans S, Emery JD, IJzerman M, Ristevski E. Health-related quality of life in rural cancer survivors compared with their urban counterparts: a systematic review. Support Care Cancer 2024; 32:424. [PMID: 38864894 PMCID: PMC11168981 DOI: 10.1007/s00520-024-08618-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE We conducted a systematic review to describe health-related quality of life (HRQOL) in rural cancer survivors (RCS), and compare HRQOL between RCS and urban cancer survivors (UCS). METHOD We searched Medline, Embase, CINAHL Plus, and PsycINFO for studies with HRQOL in adult cancer survivors living in rural, regional, remote, and urban areas, who had completed definitive primary cancer treatment, without evidence of residual disease. Where available, we used normative and clinically important values to ascribe meaning to HRQOL data. FINDINGS Fifteen studies (16 papers) were included. Most were from the US (n = 8) and reported on breast cancer survivors (n = 9). Six HRQOL instruments, collecting data across 16 domains, were used. Three instruments were specific to the survivorship phase. Normative and clinical data were available for 12 studies. Compared with normative populations, RCS had clinically worse physical HRQOL (6/12 studies), better social/family (5/7), and functional (3/6) HRQOL, and there were no differences in emotional or/mental HRQOL (9/12). In six studies with rural-urban comparator groups and normative and clinically important data, RCS and UCS had clinically worse physical (3/6 and 2/6, respectively) and better social/family (3/4 and 2/4 studies, respectively) HRQOL than normative populations. Functional HRQOL was better in RCS (2/4 studies) than UCS and normative populations. In 3/6 studies, there were no clinical differences in emotional or/mental HRQOL between RCS, UCS, and normative populations. CONCLUSION Overall, HRQOL is not clearly better or worse in RCS than UCS. Future research should include different tumor types, rural residents, and survivorship-specific HRQOL instruments.
Collapse
Affiliation(s)
- S Latham
- Department of Oncology, Monash Health, Clayton, Victoria, Australia
- Department of Oncology, Eastern Health, Box Hill, Victoria, Australia
- Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - M J Leach
- School of Rural Health, Monash University, Bendigo, VIC, Australia
| | - V M White
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - K Webber
- Department of Oncology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - M Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, , Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - K Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, , Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - N Davis
- Cancer Survivor, Melbourne, Australia
| | - J L Millar
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - S Evans
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J D Emery
- Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Cancer Research, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - M IJzerman
- Centre for Health Policy, Cancer Health Services Research, Melbourne School of Population and Global/Total Health, The University of Melbourne, Carlton, Victoria, Australia
| | - E Ristevski
- School of Rural Health, Monash University, 15 Sargeant Street, Warragul, VIC, 3820, Australia.
| |
Collapse
|
2
|
Crowe L, Brown M, Bojke A, Bojke R, Greystoke A, Lecouturier J, Richardson J, Wells M, Todd A, Sharp L. Assessing the unmet needs of patients with advanced cancer treated by biological and precision therapies: protocol for TARGET, a mixed methods study. BMJ Open 2023; 13:e066229. [PMID: 37142322 PMCID: PMC10163501 DOI: 10.1136/bmjopen-2022-066229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Biological and precision therapies are increasingly used in cancer treatment. Although they may improve survival, they are also associated with various-and unique-adverse effects, which can be long lasting. Little is known about the experiences of people treated with these therapies. Moreover, their supportive care needs have not been fully explored. Consequently, it is unclear whether existing instruments adequately capture the unmet needs of these patients. The TARGET study seeks to address these evidence gaps by exploring the needs of people treated with these therapies with the aim of developing an unmet needs assessment instrument for patients on biological and precision therapies. METHODS AND ANALYSIS The TARGET study will adopt a multi-methods design involving four Workstreams (1) a systematic review to identify, describe and assess existing unmet needs instruments in advanced cancer; (2) qualitative interviews with patients on biological and precision therapies, and their healthcare professionals, to explore experiences and care needs; (3) development and piloting of a new (or adapted) unmet needs questionnaire (based on the findings of Workstream 1 and Workstream 2) designed to capture the supportive care needs of these patients; and finally, (4) a large-scale patient survey using the new (or modified) questionnaire to determine (a) the psychometric properties of the questionnaire, and (b) the prevalence of unmet needs in these patients. Based on the broad activity of biological and precision therapies, the following cancers will be included: breast, lung, ovarian, colorectal, renal and malignant melanoma. ETHICS AND DISSEMINATION This study was approved by National Health Service (NHS) Heath Research Authority Northeast Tyne and Wear South Research Ethics Committee (REC ref: 21/NE/0028). Dissemination of the research findings will take several formats to reach different audiences, including patients, healthcare professionals and researchers.
Collapse
Affiliation(s)
- Lisa Crowe
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Morven Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Andy Bojke
- Patient and Public Involvement, Newcastle upon Tyne, UK
| | - Rona Bojke
- Patient and Public Involvement, Newcastle upon Tyne, UK
| | - Alastair Greystoke
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jan Lecouturier
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James Richardson
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mary Wells
- Nursing Directorate, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| |
Collapse
|
3
|
Badger TA, Segrin C, Crane TE, Chalasani P, Arslan W, Hadeed M, Sikorskii A. Social Determinants of Health and Symptom Burden During Cancer Treatment. Nurs Res 2023; 72:103-113. [PMID: 36729777 PMCID: PMC9991997 DOI: 10.1097/nnr.0000000000000636] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cancer survivors (defined as individuals from diagnosis to the end of life) in treatment experience multiple physical and psychological symptoms (e.g., fatigue, pain, depression, anxiety, disturbed sleep) that influence their well-being and treatment outcomes. Underrepresented cancer survivors may disproportionately experience greater symptom burden (number of symptoms, symptom severity, depression, anxiety). OBJECTIVES The aim of this study was to examine the relationships of social determinants of health, including age, ethnicity, education, income and whether income meets the survivor's needs, neighborhood (rural vs. urban), access to healthcare (e.g., insurance), and social isolation, with symptom burden in cancer survivors. METHODS This secondary analysis included baseline data from 400 cancer survivors of solid tumor cancers undergoing chemotherapy or targeted therapy who participated in a larger randomized trial of symptom management interventions. Symptom burden was measured by the Center for Epidemiological Studies-Depression scale for depression and Patient-Reported Outcomes Measurement Information System scores for anxiety and social isolation, summed severity index of 16 symptoms from the General Symptom Distress Scale, and the total number of symptoms. Self-reported comorbid conditions were measured using the Bayliss tool. General linear models were used to relate symptom measures (one at a time) to age, number of comorbid conditions, level of education, marital status, income meeting needs, and size of metropolitan neighborhood. Additional covariates included site of cancer, its treatment, and whether the cancer was metastatic. RESULTS Non-Hispanic White survivors ( n = 191) were older and had more comorbid conditions, a higher proportion of metastatic cancers, and higher levels of education and income compared with Hispanic survivors ( n = 168) and non-Hispanic survivors of other races ( n = 41). Compared with the other two groups, Hispanic survivors had the lowest rate of health insurance availability, and non-Hispanic survivors of other races had the lowest social isolation. Age, number of comorbid conditions, and social isolation were significantly associated with number of symptoms, symptom severity, and depression. Age and social isolation were associated with anxiety. In addition, the symptom severity of non-Hispanic White survivors was lower than that of Hispanic survivors and non-Hispanic survivors of other races. DISCUSSION These findings highlight the health disparities in symptom burden experienced among cancer survivors when considering their social determinants of health. Assessing these may help clinicians address health disparities in cancer care.
Collapse
|
4
|
El Battioui F, El Malki F, Barrijal S. Quality of life assessment of breast cancer survivors in Northern Morocco: Rural-urban disparity. Breast Dis 2023; 42:291-298. [PMID: 37742628 DOI: 10.3233/bd-230012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
This article is a cross-sectional study of 216 women undergoing adjuvant hormone therapy for breast cancer in two oncology centers in northern Morocco. Quality of life (QoL) was assessed using the Functional Assessment of Cancer Therapy (FACT) questionnaire and its endocrine subscale (ES). The relationship between rural-urban status in our sample and QoL was assessed by linear regression analysis using sociodemographic and clinical variables as covariates. Our results show that physical and functional well-being are significantly (p < 0.001) higher in rural areas (24 and 29, respectively) than in urban areas (16 and 19, respectively), while social and emotional well-being are significantly (p < 0.001) higher in urban areas (22 and 21, respectively) than in rural areas (15 and 16, respectively). However, there was no significant difference (p = 0.097) between rural and urban breast cancer survivors regarding endocrine symptom burden. Regarding the effect of sociodemographic and clinical factors on overall HRQOL of breast cancer survivors, hormone type was shown to have a significant effect on overall HRQOL (FACT-ES) of rural and urban breast cancer survivors (𝛽 = +0.849 and 𝛽 = +0.678, respectively). A similar effect was observed for ES (𝛽 = +0.896 and 𝛽 = +0.180, respectively).In contrast, other factors (age, marital status, economic status, menopausal status, type of surgery) did not have a significant effect on HRQOL (FACT-ES) or ES.The study highlighted the need for increased psychosocial supportive care efforts for rural breast cancer survivors to improve their QoL.
Collapse
Affiliation(s)
- Fadoua El Battioui
- Laboratory of Biotechnology, Genomic and Bioinformatics, Faculty of Science and Techniques, Tangier, Abdelmalek Essaâdi University, Tetouan, Morocco
| | | | - Said Barrijal
- Laboratory of Biotechnology, Genomic and Bioinformatics, Faculty of Science and Techniques, Tangier, Abdelmalek Essaâdi University, Tetouan, Morocco
| |
Collapse
|
5
|
Moore JX, Andrzejak SE, Jones S, Han Y. Exploring the intersectionality of race/ethnicity with rurality on breast cancer outcomes: SEER analysis, 2000-2016. Breast Cancer Res Treat 2023; 197:633-645. [PMID: 36520228 PMCID: PMC9883364 DOI: 10.1007/s10549-022-06830-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/30/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Disparities in breast cancer survival have been observed within marginalized racial/ethnic groups and within the rural-urban continuum for decades. We examined whether there were differences among the intersectionality of race/ethnicity and rural residence on breast cancer outcomes. METHODS We performed a retrospective analysis among 739,448 breast cancer patients using Surveillance Epidemiology and End Results (SEER) 18 registries years 2000 through 2016. We conducted multilevel logistic-regression and Cox proportional hazards models to estimate adjusted odds ratios (AORs) and hazard ratios (AHRs), respectively, for breast cancer outcomes including surgical treatment, radiation therapy, chemotherapy, late-stage disease, and risk of breast cancer death. Rural was defined as 2013 Rural-Urban Continuum Codes (RUCC) of 4 or greater. RESULTS Compared with non-Hispanic white-urban (NH-white-U) women, NH-black-U, NH-black-rural (R), Hispanic-U, and Hispanic-R women, respectively, were at increased odds of no receipt of surgical treatment (NH-black-U, AOR = 1.98, 95% CI 1.91-2.05; NH-black-R, AOR = 1.72, 95% CI 1.52-1.94; Hispanic-U, AOR = 1.58, 95% CI 1.52-1.65; and Hispanic-R, AOR = 1.40, 95% CI 1.18-1.67), late-stage diagnosis (NH-black-U, AOR = 1.32, 95% CI 1.29-1.34; NH-black-R, AOR = 1.29, 95% CI 1.22-1.36; Hispanic-U, AOR = 1.25, 95% CI 1.23-1.27; and Hispanic-R, AOR = 1.17, 95% CI 1.08-1.27), and increased risks for breast cancer death (NH-black-U, AHR = 1.46, 95% CI 1.43-1.50; NH-black-R, AHR = 1.42, 95% CI 1.32-1.53; and Hispanic-U, AHR = 1.10, 95% CI 1.07-1.13). CONCLUSION Regardless of rurality, NH-black and Hispanic women had significantly increased odds of late-stage diagnosis, no receipt of treatment, and risk of breast cancer death.
Collapse
Affiliation(s)
- Justin Xavier Moore
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA USA ,Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, GA USA ,Cancer Prevention, Control, & Population Health Program, Department of Medicine, Institute of Public and Preventive Health, Medical College of Georgia at Augusta University, 1410 Laney Walker Blvd. CN-2135, Augusta, GA 30912 USA
| | - Sydney Elizabeth Andrzejak
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA USA
| | - Samantha Jones
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA USA
| | - Yunan Han
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110 USA
| |
Collapse
|
6
|
Chu JN, Canchola AJ, Keegan THM, Nickell A, Oakley-Girvan I, Hamilton AS, Yu RL, Gomez SL, Shariff-Marco S. Evaluating the Impact of Social and Built Environments on Health-Related Quality of Life among Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2022; 31:161-174. [PMID: 34728471 PMCID: PMC8755614 DOI: 10.1158/1055-9965.epi-21-0129] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/07/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND With almost 17 million U.S. cancer survivors, understanding multilevel factors impacting health-related quality of life (HRQOL) is critical to improving survivorship outcomes. Few studies have evaluated neighborhood impact on HRQOL among cancer survivors. METHODS We combined sociodemographic, clinical, and behavioral data from three registry-based studies in California. Using a three-level mixed linear regression model (participants nested within block groups and study/regions), we examined associations of both independent neighborhood attributes and neighborhood archetypes, which capture interactions inherent among neighborhood attributes, with two HRQOL outcomes, physical (PCS) and mental (MCS) composite scores. RESULTS For the 2,477 survivors, 46% were 70+ years, 52% were non-Hispanic White, and 53% had localized disease. In models minimally adjusted for age, stage, and cancer recurrence, HRQOL was associated with neighborhood socioeconomic status (nSES), racial/ethnic composition, population density, street connectivity, restaurant environment index, traffic density, urbanicity, crowding, rental properties, and non-single family units. In fully adjusted models, higher nSES remained associated with better PCS, and restaurant environment index, specifically more unhealthy restaurants, associated with worse MCS. In multivariable-adjusted models of neighborhood archetype, compared with upper middle-class suburb, Hispanic small town and inner city had lower PCS, and high status had higher MCS. CONCLUSIONS Among survivors, higher nSES was associated with better HRQOL; more unhealthy restaurants were associated with worse HQROL. As some neighborhood archetypes were associated with HRQOL, they provide an approach to capture how neighborhood attributes interact to impact HRQOL. IMPACT Elucidating the pathways through which neighborhood attributes influence HRQOL is important in improving survivorship outcomes.
Collapse
Affiliation(s)
- Janet N Chu
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Theresa H M Keegan
- Department of Internal Medicine, University of California Davis, Davis, California
| | | | | | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California
| | - Rosa L Yu
- Department of Medicine, Beth Israel Deaconess Medical Center, New York, New York
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| |
Collapse
|
7
|
Socha M, Sobiech KA. Socio-Demographic and General Health Factors Associated with Quality of Life in Long-Term Breast Cancer Survivors from Southwestern Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179321. [PMID: 34501909 PMCID: PMC8430910 DOI: 10.3390/ijerph18179321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 02/03/2023]
Abstract
Background: Identification of factors associated with quality of life (QOL) in breast cancer survivors can contribute to better functioning in this group of patients. The study aimed to assess the association between QOL and anthropometric, sociodemographic, and medical characteristics in postmastectomy women from southwestern Poland, 9.4 (±6.5) years after completed treatment. Materials and methods: QOL was estimated with the SF-36v2 questionnaire in 250 survivors aged 62.8 (±8.0) years with previously histologically confirmed invasive breast cancer. Results: Women in this study rated their overall QOL with an average of 60.7 (±17.9), Mental Component Summary of 62.8 (±19.8), and Physical Component Summary of 57.5 (±18.8) points. The use of multivariate regression analysis revealed that depression, chronic diseases, abdominal obesity, and pregnancy history have a statistically significant negative effect on the QOL of women after mastectomy, whereas participation in regular physical activity, living with a partner, the education level ≥ 12 years, and living in the city were associated with a higher QOL assessment. There were no significant relationships between QOL and the age, time since surgery, type of treatment, smoking, and occupational status of the patients. Conclusions: Health education, greater social support, specialist care in the treatment of comorbidities, and propagation of a physically active lifestyle can improve the physical and mental functioning of breast cancer survivors long after diagnosis and treatment.
Collapse
|
8
|
van der Kruk SR, Butow P, Mesters I, Boyle T, Olver I, White K, Sabesan S, Zielinski R, Chan BA, Spronk K, Grimison P, Underhill C, Kirsten L, Gunn KM. Psychosocial well-being and supportive care needs of cancer patients and survivors living in rural or regional areas: a systematic review from 2010 to 2021. Support Care Cancer 2021; 30:1021-1064. [PMID: 34392413 PMCID: PMC8364415 DOI: 10.1007/s00520-021-06440-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/13/2021] [Indexed: 01/16/2023]
Abstract
Purpose To summarise what is currently known about the psychosocial morbidity, experiences, and needs of people with cancer and their informal caregivers, who live in rural or regional areas of developed countries. Methods Eligible studies dating from August 2010 until May 2021 were identified through several online databases, including MEDLINE, EMBASE, PsychINFO, and RURAL (Rural and Remote Health Database). Results were reported according to the PRISMA guidelines and the protocol was registered on PROSPERO (CRD42020171764). Results Sixty-five studies were included in this review, including 20 qualitative studies, 41 quantitative studies, and 4 mixed methods studies. Qualitative research demonstrated that many unique psychosocial needs of rural people remain unmet, particularly relating to finances, travel, and accessing care. However, most (9/19) quantitative studies that compared rural and urban groups reported no significant differences in psychosocial needs, morbidity, or quality of life (QOL). Five quantitative studies reported poorer psychosocial outcomes (social and emotional functioning) in urban cancer survivors, while three highlighted poorer outcomes (physical functioning, role functioning, and self-reported mental health outcomes) in the rural group. Conclusion Recent research shows that rural people affected by cancer have unique unmet psychosocial needs relating to rurality. However, there was little evidence that rural cancer survivors report greater unmet needs than their urban counterparts. This contrasts to the findings from a 2011 systematic review that found rural survivors consistently reported worse psychosocial outcomes. More population-based research is needed to establish whether uniquely rural unmet needs are due to general or cancer-specific factors.
Collapse
Affiliation(s)
- Shannen R. van der Kruk
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- Cancer Research Institute, University of South Australia, Adelaide, SA Australia
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW Australia
| | - Ilse Mesters
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Terry Boyle
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA Australia
| | - Ian Olver
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA Australia
| | - Kate White
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Sabe Sabesan
- College of Medicine and Dentistry (CMD), James Cook University, QLD, Townsville, Australia
| | - Rob Zielinski
- Central West Cancer Care Centre, Orange Base Hospital, Orange, NSW Australia
- Western Sydney University, Sydney, NSW Australia
| | - Bryan A. Chan
- School of Medicine, Griffith University, Brisbane, QLD Australia
| | - Kristiaan Spronk
- Cancer Research Institute, University of South Australia, Adelaide, SA Australia
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA Australia
| | - Peter Grimison
- Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, NSW Australia
| | | | | | - Kate M. Gunn
- Cancer Research Institute, University of South Australia, Adelaide, SA Australia
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA Australia
| | | |
Collapse
|
9
|
Fitch MI, Lockwood G, Nicoll I. Physical, emotional, and practical concerns, help-seeking and unmet needs of rural and urban dwelling adult cancer survivors. Eur J Oncol Nurs 2021; 53:101976. [PMID: 34111722 DOI: 10.1016/j.ejon.2021.101976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study explores the influence of residency location on the experiences of cancer survivors. The influence of where individuals live during cancer screening, diagnosis, and treatment has been described in various countries. However, understanding the context of residency on experiences during survivorship has received less attention. METHODS A survey was designed to assess experiences of cancer survivors transitioning to follow-up care. Descriptive statistics were used to contrast physical, emotional, and practical concerns, help-seeking, and unmet needs of rural and urban dwelling respondents. Difference in proportions of greater than 5% were considered clinically meaningful. RESULTS In total, 13,319 respondents completed the survey of which 4646 met the criteria for rural dwelling (e.g., living in villages or towns with 10,000 or less residents or on an acreage, ranch, or farm). Proportions of respondents in rural and urban groups were similar in terms of level of concerns. Differences were observed for help seeking regarding return to work and for difficulty in obtaining help regarding taking care of children and other family members, changes in relationships with family, friends and co-workers, and getting to and from appointments. Unmet needs existed across all domains and were similar in both groups. A larger proportion of rural dwelling respondents experienced unmet needs regarding return to work. CONCLUSIONS [implications]: High proportions of cancer survivors experienced concerns following cancer treatment. However, rural dwelling survivors were more challenged in obtaining help for selected concerns. Implications exist for development of community-based support services in rural settings.
Collapse
Affiliation(s)
- Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, 207 Chisholm Ave., Toronto, Ontario, M4C 4V9, Canada.
| | - Gina Lockwood
- Biostatistician Consultant (Independent), Toronto, Canada.
| | - Irene Nicoll
- Health Care Consultant (Independent), Toronto, Canada.
| |
Collapse
|
10
|
Postavaru GI, Myers B, Ahmed T, Lewins D, Brown R, Swaby H. A Study Protocol to Explore and Improve Access to Medical Services and Information for Recently Diagnosed Elderly Patients with Cancer in Rural Settings. Int J Surg Protoc 2021; 25:66-70. [PMID: 34013147 PMCID: PMC8114844 DOI: 10.29337/ijsp.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction This two-phase study seeks to contribute to research in the field of rural cancer health; specifically, the aim is to gain insight into the experiences of seeking, accessing and using information and health services throughout the cancer journey (diagnosis, treatment and follow-up care) for recently diagnosed (≤6 months) older patients (≥65 years) in rural areas. Methods and analysis Data will be collected through in-depth semi-structured interviews. In phase 1 (before 23rd March 2020) interviews were conducted with healthcare professionals (HCP) to explore their experiences of delivering care to their elderly patients. In the second phase (starting January 2021) we will conduct interviews with cancer patients to understand the impact of COVID-19 and shielding on their experiences of being diagnosed, attending appointments and accessing and receiving support from community organisations and informal support from family and friends. Data gathered will be analysed using the Framework Method. Ethics The study has been approved by the Health Research Authority and the United Lincolnshire Hospitals NHS Trust. Initial favourable ethical opinion was granted on 1st October 2019. Second favourable ethical opinion for amendments to reflect the impact of COVID-19 was received on 10th August 2020. The study protocol has been registered on Research Registry.
Collapse
Affiliation(s)
- Gianina-Ioana Postavaru
- Bishop Grosseteste University, Lincoln, UK.,United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Bethan Myers
- Leicestershire Partnership NHS Trust, Leicester, UK
| | - Tanweer Ahmed
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | | | | | | |
Collapse
|
11
|
Anbari AB, Ostby P, Ginex PK. Breast Cancer–Related Lymphedema: Personalized Plans of Care to Guide Survivorship. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00380-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
12
|
Smith L, Downing A, Norman P, Wright P, Hounsome L, Watson E, Wagland R, Selby P, Kind P, Donnelly DW, Butcher H, Huws D, McNair E, Gavin A, Glaser AW. Influence of deprivation and rurality on patient-reported outcomes of men living with and beyond prostate cancer diagnosis in the UK: A population-based study. Cancer Epidemiol 2020; 69:101830. [PMID: 33002843 DOI: 10.1016/j.canep.2020.101830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the UK, inequalities exist in prostate cancer incidence, survival and treatment by area deprivation and rurality. This work aimed to identify variation in patient-reported outcomes of men with prostate cancer by area type. METHODS A population-based survey of men 18-42 months after prostate cancer diagnosis (N = 35608) measured self-assessed health (SAH) using the EQ-5D and five functional domains using the Expanded Prostate Cancer Index Composite (EPIC-26). RESULTS Mean SAH was higher for men in least deprived areas compared to most deprived (difference 6.3 (95 %CI 5.6-7.2)). SAH scores were lower for men in most urban areas compared to most rural (difference 2.4 (95 %CI 1.8-3.0)). Equivalent estimates in the general population reported a 13 point difference by deprivation and a 4 point difference by rurality. For each EPIC-26 domain, functional outcomes were better for men in the least deprived areas, with clinically meaningful differences observed for urinary incontinence and hormonal function. There were no clinically meaningful differences in EPIC-26 outcomes by rurality with less than a three point difference in scores for each domain between urban and rural areas. CONCLUSION In men 18-42 months post diagnosis of prostate cancer in the UK, impacts of area deprivation and rurality on self-assessed health related quality of life were not greater than would be expected in the general population. However, clinically meaningful differences were identified for some prostate functional outcomes (urinary and hormonal function) by deprivation. No impact by rurality of residence was identified.
Collapse
Affiliation(s)
- Lesley Smith
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK.
| | - Amy Downing
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | - Eila Watson
- Department of Midwifery, Community and Public Health, School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Peter Selby
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Kind
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - David W Donnelly
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Hugh Butcher
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Dyfed Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Emma McNair
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Adam W Glaser
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
13
|
Polek C, Hardie T, Deatrick JA. Breast Cancer Survivorship Experiences of Urban Hispanic Women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:923-929. [PMID: 31098836 DOI: 10.1007/s13187-019-01543-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to explore determinates of health that impact survivorship of urban Hispanic breast cancer survivors who are at risk for experiencing poorer outcomes than others. Some challenges have been characterized, but gaps in our knowledge of the impact of some of the social determinates of health remain. Challenges likely exist prior to a diagnosis of cancer and may amplify in intensity during survivorship, potentially shortening survival and quality of life of these women. A narrative, focus group was conducted with a group of urban Hispanic breast cancer survivors. A series of linked vignettes describing survivorship challenges and late effects of breast cancer pathology and treatment were used to stimulate discussion. Three themes impacting survivorship were identified. The themes included communication (health literacy), isolation, and social support and financial cost. Communication issues resulted in delays in treatment denial of services. While these themes in cancer survivors are independent of residence (rural, suburban, or urban) and across ethnic groups, some unique issues were identified in urban Hispanic breast cancer survivors. Members of the healthcare team are in a unique position to enhance survivor's health literacy, advocate for programmatic efforts to enhance navigation roles in the hospital and communities, decrease delays in initiating care, and decrease the rate of patients lost.
Collapse
Affiliation(s)
| | - Thomas Hardie
- University of Pennsylvania, Philadelphia, PA, 19104, USA
| | | |
Collapse
|
14
|
Symptom Burden of Nonresected Pancreatic Adenocarcinoma: An Analysis of 10,753 Patient-Reported Outcome Assessments. Pancreas 2020; 49:1083-1089. [PMID: 32769858 DOI: 10.1097/mpa.0000000000001629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Pancreatic adenocarcinoma (PAC) is a debilitating disease. We sought to analyze symptom burden and trajectories after diagnosis of PAC and identify predictors of severe symptoms for nonresected patients. METHODS This was a retrospective review of linked administrative health care databases examining patients with PAC not undergoing resection. Primary outcome was severe patient-reported symptoms (Edmonton Symptom Assessment System ≥7). Multivariable modified Poisson regression models were used to identify factors associated with reporting severe symptoms. RESULTS A total of 10,753 symptom assessments from 2168 patients were analyzed. The median age was 67 years, and 47% were female; median survival was 7 months. Most common severe symptoms were tiredness (54.7%), anorexia (53.6%), overall impaired well-being (45.3%), and drowsiness (37.1%). Severity of symptoms decreased 1 month after diagnosis and plateaued 4 months after diagnosis. Female sex, comorbidities, and older age were associated with reporting severe symptoms; recent radiation treatment and residence in a rural community were associated with reporting less severe symptoms. CONCLUSIONS The prevalence of severe symptoms in patients with nonresected PAC was high, but potentially modifiable. We identified vulnerable groups of patients that may benefit from focused interventions. This information is important for patient counseling and design of supportive care strategies.
Collapse
|
15
|
Noonan D, LeBlanc M, Conley C, Benecha H, Leak-Bryant A, Peter K, Zimmerman S, Mayer D, Smith S. Quality of Life and Impact of Cancer: Differences in Rural and Nonrural Non-Hodgkin's Lymphoma Survivors. J Rural Health 2020; 36:536-542. [PMID: 32472708 DOI: 10.1111/jrh.12420] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE People living in rural areas experience greater health disparities than their nonrural counterparts, but little is known about the association between rural status and quality of life (QOL) in non-Hodgkin's lymphoma (NHL) survivors. We compared self-reported quality of life and impact of cancer in rural and nonrural NHL survivors. METHODS This study is a secondary analysis of 566 NHL cancer survivors recruited from cancer registries at 2 large academic medical centers in 1 state. Standardized measures collected information on demographics and clinical characteristics, quality of life (QOL; SF-36), and the Impact of Cancer (IOCv2). Rural residence was determined by Rural-Urban Commuting Area (RUCA) codes designated as nonmetropolitan. Multiple linear regression analysis, adjusted for demographic and clinical covariates, was used to evaluate the relationship between rural residence and QOL and impact of cancer. FINDINGS Among the 566 participants (83% response rate), rural residence was independently associated with lower SF-36 physical component summary scores and the physical function subscale (all P < .05). Rural residence was also associated with higher IOCv2 positive impact scores and the subscales of altruism/empathy and meaning of cancer scores in the adjusted models (all P < .05). CONCLUSIONS Given documented rural cancer disparities and the lack of resources in rural communities, study findings support the continued need to provide supportive care to rural cancer survivors to improve their QOL. Consistent with previous research, rural residence status is associated with increased positive impact following cancer diagnosis.
Collapse
Affiliation(s)
- Devon Noonan
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, NC, USA
| | - Matthew LeBlanc
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, NC, USA
| | - Cherie Conley
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, NC, USA
| | - Habtamu Benecha
- Formerly at University of North Carolina at Chapel Hill, Department of Biostatistics, Chapel Hill, NC, USA
| | | | - Kellen Peter
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, NC, USA
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Deborah Mayer
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Sophia Smith
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, NC, USA
| |
Collapse
|
16
|
Suppressive effects of capsaicin against N-nitrosomethylurea-induced mammary tumorigenesis in rats. Biomed Pharmacother 2018; 98:673-679. [DOI: 10.1016/j.biopha.2017.12.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/09/2017] [Accepted: 12/13/2017] [Indexed: 11/17/2022] Open
|
17
|
Gou Z, Xie X, Lu Y, Khoshbakht M. Quality of Life (QoL) Survey in Hong Kong: Understanding the Importance of Housing Environment and Needs of Residents from Different Housing Sectors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020219. [PMID: 29382071 PMCID: PMC5858288 DOI: 10.3390/ijerph15020219] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 11/26/2022]
Abstract
This study presents a Quality of Life (QoL) survey to understand the influence of the housing environment and needs of residents from different housing sectors. The research focuses on Hong Kong where living conditions have become the main affect for people’s QoL. Through a household survey using a standard instrument “Word Health Organisation (WHO) Quality of Life-BREF”, the article found that among the four WHO QoL domains (Physical Health, Psychological Health, Social Relations And Environment), Environment, particularly its constitute aspect housing environment was the most influential factor for overall quality of life for the public rental housing sector where low-income people live. This research also found that different groups of people have differing needs of their housing environments: the low-income group needs better location and privacy while the medium and high-income groups need better architectural quality. Based on differentiating their needs and wants, this research argues for prioritizing the low-income group’s needs for effectively improving their QoL.
Collapse
Affiliation(s)
- Zhonghua Gou
- School of Engineering and Built Environment, Griffith University, Gold Coast, QLD 4215, Australia.
| | - Xiaohuan Xie
- School of Architecture and Urban Planning, Shenzhen University, Shenzhen 518060, China.
- Shenzhen Key Laboratory of Built Environment Optimization, Shenzhen University, Shenzhen 518060, China.
| | - Yi Lu
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, China.
| | - Maryam Khoshbakht
- School of Engineering and Built Environment, Griffith University, Gold Coast, QLD 4215, Australia.
| |
Collapse
|
18
|
Baade P. Geographical Variation in Breast Cancer Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14050523. [PMID: 28498324 PMCID: PMC5451974 DOI: 10.3390/ijerph14050523] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Peter Baade
- Cancer Research Centre, Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
| |
Collapse
|