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.
Background
Treatment delays affect breast cancer survival and constitute poor‐quality care. Black patients experience more treatment delay, but the relationship of geography to these disparities is poorly understood.
Methods
We studied a population‐based, retrospective, observational cohort of patients with breast cancer in North Carolina between 2004 and 2017 from the Cancer Information and Population Health Resource, which links cancer registry and sociodemographic data to multipayer insurance claims. We included patients >18 years with Stage I–III breast cancer who received surgery or chemotherapy as their first treatment. Delay was defined as >60 days from diagnosis to first treatment. Counties were aggregated into nine Area Health Education Center regions. Race was dichotomized as Black versus non‐Black.
Results
Among 32,626 patients, 6190 (19.0%) were Black. Black patients were more likely to experience treatment delay >60 days (15.0% of Black vs. 8.0% of non‐Black). Using race‐stratified modified Poisson regression, age‐adjusted relative risk of delay in the highest risk region was approximately twice that in the lowest risk region among Black (relative risk, 2.1; 95% CI, 1.6–2.6) and non‐Black patients (relative risk, 1.9; 95% CI, 1.5–2.3). Adjustment for clinical and sociodemographic features only slightly attenuated interregion differences. The magnitude of the racial gap in treatment delay varied by region, from 0.0% to 9.4%.
Conclusions
Geographic region was significantly associated with risk of treatment delays for both Black and non‐Black patients. The magnitude of racial disparities in treatment delay varied markedly between regions. Future studies should consider both high‐risk geographic regions and high‐risk patient groups for intervention to prevent delays.
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