Comparative Assessment of Quality of Life in Urban Versus Rural Breast Cancer Survivors in Pakistan
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Abstract
Background: Breast cancer survival has improved, but long-term quality of life remains an important survivorship concern, particularly in settings where rural and urban populations experience unequal access to oncology follow-up, rehabilitation, and psychosocial support. Objective: This study aimed to compare breast-cancer-specific quality-of-life domains between rural and urban breast cancer survivors in Faisalabad, Pakistan. Methods: A descriptive analytical cross-sectional study was conducted among 309 breast cancer survivors attending the outpatient departments of Allied Hospital and Punjab Institute of Nuclear Medicine Hospital, Faisalabad. Participants were selected using purposive sampling. Quality of life was assessed using the EORTC QLQ-BR42 questionnaire. Descriptive statistics summarized participant characteristics and domain scores, while independent-sample t-tests compared rural and urban survivors. Statistical significance was set at p < 0.05. Results: The mean age of participants was 44.19 ± 11.28 years. Of 309 survivors, 165 (53.4%) were from rural areas and 144 (46.6%) from urban areas. Urban survivors had significantly higher scores for sexual functioning (p = 0.040), sexual enjoyment (p = 0.028), and future perspective (p = 0.010), while rural survivors had significantly higher systemic therapy side effects, breast symptoms, arm symptoms, hair-loss distress, targeted therapy symptoms, endocrine therapy symptoms, mucosal symptoms, and extended BR42 composite scores. Body image did not differ significantly between groups (p = 0.865). Conclusion: Rural breast cancer survivors experienced greater symptom burden, whereas urban survivors reported better selected functional and psychosocial domains. These findings support decentralized survivorship care, rural rehabilitation services, symptom-management pathways, and culturally sensitive psychosocial support in Pakistan
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