Sequelae of Breast Cancer and the Influence of Menopausal Status at Diagnosis Among Rural Breast Cancer Survivors

Background: Rural women are among the largest medically underserved groups in the nation, yet few studies have evaluated the sequelae of breast cancer in this population. The purpose of this study was to examine the physical and psychosocial effects of breast cancer experienced by rural survivors at the time of treatment and currently and to examine differences in these effects between younger and older rural survivors based on menopausal status at diagnosis. Methods: Women treated for breast cancer within the past 6 years at one of three rural cancer centers were mailed a survey with a cover letter from their oncology provider. Results: Survey respondents (n = 918, 83% response rate) were 67 +/- 13 years old, on average 3.2 years from treatment, 22% were premenopausal at the time of breast cancer diagnosis, and 95% were postmenopausal at the time of the survey. Women who were premenopausal at diagnosis were significantly more likely to experience numerous symptoms at the time of treatment and currently, including higher rates of hot flashes, vaginal dryness, loss of sexual desire, and weight gain (p <= 0.001). The most common psychosocial concerns were fear of recurrence and change in body image, and women premenopausal at diagnosis were significantly more likely than postmenopausal women to report experiencing these concerns (68% vs. 47%, and 43% vs. 27%, respectively, p <= 0.001). Conclusions: Negative physical and psychosocial sequelae of breast cancer were common in this rural sample and were significantly worse for premenopausal women. Research and resources are needed for delivering targeted survivorship care to rural women, particularly younger rural women.