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Comparing the roles of social context, networks, and perceived social functioning with health-related quality of life among self-reported rural female cancer survivors

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Abstract

Purpose

Rural women, compared to urban, experience worse survivorship outcomes, including poorer health-related quality of life (QOL). There is a need to characterize the role of multilevel social factors that contribute to QOL, including context, networks, and functioning. Our objectives were to (1) use latent class analysis to identify distinct classes of social context and social networks and (2) examine how multilevel social factors (context, networks, and functioning) are associated with health-related QOL.

Methods

We recruited self-identified rural survivors to the Illinois Rural Cancer Assessment (2017–2018), via community-based sampling methods, and participants completed the survey online, by phone, or on paper. We used latent class analysis to generate multidimensional variables for contextual and network factors. We next modeled each social factor sas a predictor in separate, bivariable linear regressions for the QOL outcomes, followed by multivariable, adjusted regressions.

Results

For our first objective, there were three classes each of county-level contexts (1, highly rural, socioeconomically disadvantaged, and mostly lacking in cancer-related services; 2, mostly rural, moderately disadvantaged, and underserved; 3, mostly metropolitan, less disadvantaged, and most-resourced) and social networks (1, no caregivers; 2, only spousal caregivers with whom they communicated daily; 3, multiple caregivers with varying daily communication). For our second objective, among all social factors, only functioning was associated with better mental health-related QOL. No factors were associated with physical health-related QOL.

Conclusions

Our findings suggest a rich diversity of social context and networks among rural female cancer survivors, and social functioning is particularly important for mental health-related QOL.

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Acknowledgments

We thank the cancer survivors who graciously provided their time and information, thereby making this research possible. We would also like to thank the following individuals who contributed their efforts to the study: Martasia Carter, Emily Hallgren, Jocelyne Lemus, Patricia Newton, Lillian Oluchi Nwigwe, Kryztal Peña, Lillian San Miguel, Mona Strahan, and Nidhi Suthar. Lastly, this manuscript is a component of Leslie Carnahan’s working dissertation and will be included in as a chapter in the thesis.

Funding

The Illinois Rural Cancer Assessments study was an intramurally funded project supported by the University of Illinois at Chicago’s Center for Research on Women and Gender and University of Illinois Cancer Center.

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Authors and Affiliations

  1. Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA

    Leslie R. Carnahan, Karriem S. Watson, Susan Altfeld, Kristine Zimmermann & Yamilé Molina

  2. Center for Research on Women and Gender, University of Illinois at Chicago, Rm 536A, 1640 W. Roosevelt Rd., MC 980, Chicago, IL, 60608, USA

    Leslie R. Carnahan, Kristine Zimmermann & Yamilé Molina

  3. Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA

    Garth H. Rauscher

  4. University of Illinois Cancer Center, 914 S. Wood St., Chicago, IL, 60612, USA

    Karriem S. Watson

  5. Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave., Chicago, IL, 60612, USA

    Carol E. Ferrans

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  1. Leslie R. Carnahan
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Correspondence to Leslie R. Carnahan.

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Conflict of interest

Ms. Carnahan, Dr. Rauscher, Dr. Watson, Dr. Altfeld, Dr. Zimmermann, Dr. Ferrans, and Dr. Molina have no financial relationships to disclose. Ms. Carnahan reports this manuscript is a component of their working dissertation and will be included in as a chapter in the thesis. The authors have full control of all primary data and will all the journal to review the data if requested.

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Carnahan, L.R., Rauscher, G.H., Watson, K.S. et al. Comparing the roles of social context, networks, and perceived social functioning with health-related quality of life among self-reported rural female cancer survivors. Support Care Cancer 29, 331–340 (2021). https://doi.org/10.1007/s00520-020-05497-8

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