Disparities in women’s cancer-related quality of life by Southern Appalachian residence

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Purpose: The purpose was to determine whether Appalachian residence alone or in combination with violence was linked to poorer quality of life (QOL). Methods: Women recently diagnosed and included in either the Kentucky or North Carolina Cancer Registries were interviewed by phone between 2009 and 2015 (n = 3320; mean age = 56.74). Response rates were similar by state (40.1 in Kentucky and 40.9% in North Carolina). Appalachian (N = 990) versus non-Appalachian residents (N = 2330) were hypothesized to have poorer QOL defined as (a) lower Functional Assessment of Cancer Therapy—General (FACT-G) scores and (b) more symptoms of depression, stress, or comorbid physical conditions. Lifetime intimate partner or sexual violence was first investigated as a moderator then mediator of regional differences. Multiple analyses of covariance (MANCOVA) models were used. Results: Violence modified the effect of Appalachian residence on poorer QOL outcomes; FACT-G total scores (p =.02) were lowest for women living in Appalachia who had additionally experienced violence. Socioeconomic indicators appeared to mediate or explain differences in QOL outcomes by Appalachian residence such that when adjusting for income, education and insurance, Appalachian residence remained associated only with poorer physical QOL outcomes (p <.05). Conclusions: While violence rates did not differ by residence, the combined effect of living in Appalachia and experiencing violence resulted in significantly greater impact on poorer QOL among women recently diagnosed with cancer. Clinical consideration of patients’ residence, socioeconomic status and violence experienced may help identify and mitigate the longer-term impact of these identifiable factors associated with poorer QOL.

Original languageEnglish
Pages (from-to)1347-1356
Number of pages10
JournalQuality of Life Research
Issue number5
StatePublished - May 1 2018

Bibliographical note

Publisher Copyright:
© 2018, The Author(s).


  • Cancer
  • Disparities
  • Quality of life
  • Rural
  • Violence

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Disparities in women’s cancer-related quality of life by Southern Appalachian residence'. Together they form a unique fingerprint.

Cite this