Online Exclusive Article

Rural Living as Context: A Study of Disparities in Long-Term Cancer Survivors

Leli W. Pedro

Sarah J. Schmiege

survivorship, quality of life, care of the medically underserved, rural issues, health policy
ONF 2014, 41(3), E211-E219. DOI: 10.1188/14.ONF.E211-E219

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.

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