The pressing significance of the proposed study was underscored with January 2006 release of The Institute of Medicine's Report, "From cancer patient to cancer survivor: Lost in transition". The Report recommends patients receive a "survivorship care plan" including information critical to life after treatment. Yet, the Report cites serious shortfalls in follow-up care, suggesting too many survivors are lost in transition after treatment. They move from an orderly care system to a non-system where few guidelines exist to help them into and through cancer survivorship. Of over 10 million cancer survivors in the United States, 2.3 million are (22%) are breast cancer survivors. Forty percent of all female cancer survivors are breast cancer survivors;making them the largest single group of survivors. Projections reflect continued increases in the rate of survivorship in coming years. Left unaddressed, ever increasing numbers will move from an orderly system of care to a 'non system'. Rural breast cancer survivors are particularly vulnerable to being lost in transition. The lack of access to healthcare providers and survivorship services is exacerbated by communication difficulties. These conditions render them at additional risk for poor quality of life (QoL). The overall goal of the proposed project is to determine the effectiveness of the Rural Breast Cancer Survivors (RBCS) Intervention;an intervention specifically designed to address the challenges associated with rural breast cancer survivors'transition from treatment to survivorship. Seven preliminary studies supporting the efficacy of the RBCS lead us to the following aims: (1) Determine the within group effects of the Rural RBSC Intervention on overall QoL. (2) Determine the between group effects of the RBCS Intervention on overall QoL. (3) Determine the within group effects of the RBCS Intervention on physical, psychological, social, and spiritual QoL subdomains. (4) Determine the between group effects of the RBCS Intervention on physical, psychological, social, and spiritual QoL subdomains. (5) Determine baseline characteristics associated with QoL, and explore their confounding or interacting effects with the RBCS Intervention. A GEE analytical approach will be employed. This project stands to provide a structure and the content for assuring rural breast cancer survivors receive information and support necessary to avoid being lost in transition from treatment to survivorship. Such innovation is necessary if the deleterious consequences of survivorship neglect are to be avoided.
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