PurposeTo describe what is known about levels of morbidity and the experience and needs of people with cancer, and their carers, living in rural areas. MethodsA search of online databases for English language papers describing or assessing the prevalence of psychosocial morbidity or needs in a population of rural or regional cancer patients. Excluded: intervention studies, discussion of service delivery, effectiveness of support groups or support via videoconferencing, concentrated on medical outcomes or survival rates, reported differences in the uptake of cancer screening, or concentrated on health attitudes or treatment decision making. ResultsThere were 37 studies included in the review, including 25 quantitative studies (all surveys), 11 of which included a control group of urban patients, and 12 qualitative studies. Until recently, most studies had methodological short-comings. Only two prospective studies were identified, most studies focused on breast cancer and few addressed psychological morbidity. The majority of controlled studies reported worse 3 outcomes for rural patients, who appear to have higher needs in the domains of physical/daily living. This may reflect more limited access to resources, a more selfsufficient lifestyle and personal characteristics, for example, being more stoical and less likely to ask for help. The need to travel for treatment caused many practical, emotional and financial problems for patients and burdened them with additional worry concerning family and work commitments. Some patients reported benefits in sharing experiences with others also forced to stay away from home, but most agreed that staying at home was preferable. ConclusionThis review highlights that whilst we are beginning to get some insight into the needs of people with cancer in rural areas, much is still unknown. Population-based, prospective studies including people with heterogenous cancers from rural and urban settings are needed.

The frequency of CAM use we found is in line with international data from CCCs in the USA. To our knowledge, this is the first study publishing data on the frequency of potential interactions. Thus, an initiative to protect women from the dangers of uncontrolled CAM use is urgently needed. In the discussion, we propose a concept of how to achieve this aim.