Health‐related quality of life in head and neck cancer survivors: Evaluating the rural disadvantage

Abstract

Purpose Head and neck cancer (HNC) survivors often experience distress and health‐related quality of life (HRQOL) impairment. Research suggests that rural cancer patients may have poorer outcomes than urban patients. This study examined whether HNC patient emotional and HRQOL outcomes differ in those living in a rural versus urban location at 6 and 12 months postdiagnosis. Methods A total of 261 HNC patients were included from a longitudinal study of HNC outcomes. The majority were diagnosed with advanced stage cancer (51.3%); the most common cancer site was oral cavity (41.0%). Rurality was measured using the US Department of Agriculture Rural Urban Commuting Area codes. Depression was measured using the Beck Depression Inventory (BDI), general HRQOL using the Short Form‐36 (SF‐36), and HNC‐specific HRQOL using the Head and Neck Cancer Inventory (HNCI). Analyses were 2 (group) × 3 (assessment) repeated measures ANCOVAs, controlling for demographic and clinical characteristics. Findings Approximately 45% of the sample lived in a rural location. Follow‐up comparisons of significant overall models indicated that rural patients reported significantly more nonsomatic depression symptoms at 6‐month follow‐up. Rural patients were also more likely to report significantly poorer general mental HRQOL at 12‐month follow‐up, significantly poorer HNC‐specific HRQOL related to eating at 6‐ and 12‐month follow‐up, and marginally worse aesthetics at 12‐month follow‐up. Conclusions These findings are consistent with suggestions that rural HNC patients may be at heightened risk for depression symptoms and decrements in HRQOL. Patients should be screened and regularly monitored for issues with depression and HNC‐specific HRQOL throughout the survivorship period.

Problem alcohol use among rural head and neck cancer patients at diagnosis: Associations with health‐related quality of life

“…13 In a recent study of psychosocial outcomes in rural HNC patients, it was reported that rural patients experienced greater levels of depressive symptomatology and poorer HNC-specific HRQOL when compared to urban HNC patients. 14 These studies align with a larger body of evidence suggesting that outcomes, including survival, are worse among rural cancer patients of all types including breast, gynecologic, prostate, colorectal, lung, melanoma, hematologic, and HNCs [15][16][17][18][19][20] and may be exacerbated by problem alcohol use. Some work in chronic disease populations has suggested that the presence of factors that negatively impact quality of life and disease management may explain why patients in rural settings face a so-called "rural disadvantage".…”

“…35 The BDI consists of 21 items scored 0-3, each assessing a unique category of depressive symptoms. Cut-off scores have been established which suggest minimal (0-9), mild (10)(11)(12)(13)(14)(15)(16)(17)(18), moderate (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), and severe depression. 35 The BDI has been used in both nonclinical and clinical samples, including those with HNC.…”

“…For example, a recent Surveillance, Epidemiology, and End Results (SEER) database study by Pagedar and colleagues reported that the incidence of oropharynx cancer was increasing faster in rural areas, while the rates of larynx and oral cavity cancers were decreasing more rapidly in urban areas 13 . In a recent study of psychosocial outcomes in rural HNC patients, it was reported that rural patients experienced greater levels of depressive symptomatology and poorer HNC‐specific HRQOL when compared to urban HNC patients 14 . These studies align with a larger body of evidence suggesting that outcomes, including survival, are worse among rural cancer patients of all types including breast, gynecologic, prostate, colorectal, lung, melanoma, hematologic, and HNCs 15–20 and may be exacerbated by problem alcohol use.…”

“…National data suggest that rural residents, although more likely to abstain from alcohol, have similar if not higher rates of alcohol use disorder (AUD) when compared to those living in urban areas 10–12 . More broadly, there is both a greater incidence of HNC in rural areas and evidence indicating that HNC patients may experience worse outcomes than their urban counterparts 13,14 . For example, a recent Surveillance, Epidemiology, and End Results (SEER) database study by Pagedar and colleagues reported that the incidence of oropharynx cancer was increasing faster in rural areas, while the rates of larynx and oral cavity cancers were decreasing more rapidly in urban areas 13 .…”

“…[10][11][12] More broadly, there is both a greater incidence of HNC in rural areas and evidence indicating that HNC patients may experience worse outcomes than their urban counterparts. 13,14 For example, a recent Surveillance, Epidemiology, and End Results (SEER) database study by Pagedar and colleagues reported that the incidence of oropharynx cancer was increasing faster in rural areas, while the rates of larynx and oral cavity cancers were decreasing more rapidly in urban areas. 13 In a recent study of psychosocial outcomes in rural HNC patients, it was reported that rural patients experienced greater levels of depressive symptomatology and poorer HNC-specific HRQOL when compared to urban HNC patients.…”