Cancer survivorship care in rural community: Patient perspective.

Abstract

25 Background: Advances in oncologic sciences have resulted in successful treatments for many cancers with improved event-free and overall survival for millions of patients. Efficient delivery of state of the art cancer care requires well-orchestrated performances of multiple oncology, primary care and social services providers. However, many rural oncology providers do not offer such multidisciplinary cancer services and rely on patients to coordinate their own care. This study assessed perspectives of rural cancer patients and caregivers on their confidence to make decisions and address their care needs. Methods: We conducted focus groups with the attendees of 3 rural Congregate Meals. The county-sponsored programs bring together seniors for nutritional meals, social connectedness and educational programs. We also developed and piloted a 5-question survey, asking respondents to rate their confidence in interacting with their clinicians about care needs, care coordination and barriers to care. Results: Overall, 85 individuals participated in the focus groups and 76 persons returned the survey (90% response rate). The vast majority of the participants were cancer survivors or caregivers to patients with cancer. Transportation to and from oncology appointments presents a major concern for the rural communities, as most patients had to travel long distance to see a doctor. Patients also reported having difficulty making decisions regarding their care due to a lack of knowledge about specific cancer services and limited availability of providers. Cancer support groups, behavioral health providers, exercise and nutrition therapies were reported to be particularly scarce in rural areas. We found that patients who had trusted relationships with their physicians tended to be more confident in their ability to obtain necessary help from their providers compared to patients who reported poor communication and lack of trust. Conclusions: There are numerous reasons that may lead to rural-urban disparities in cancer survivorship outcomes including limited availability of supportive services, limited patient resources, burden of patient decision making and care coordination, and lack of adequate patient-provider communication.

Effect of a 12-Week Online Walking Intervention on Health and Quality of Life in Cancer Survivors: A Quasi-Randomized Controlled Trial

“…Cancer survivors living in rural and remote areas may be at an even higher risk of being insufficiently active and experiencing negative long-term effects of cancer treatment compared to their urban counterparts [ 14 , 15 ]. This disparity in health outcomes between metropolitan and rural cancer survivors may be attributable to geographical isolation, limited access to services and facilities, and the burden of travel distances [ 16 , 17 ]. Given the known benefits of physical activity on health outcomes in cancer survivors and the inequality in health outcomes between metropolitan and rural cancer survivors, there is a need for accessible health promotion interventions that meet the specific needs of both metropolitan and rural cancer survivors.…”

Patterns and predictors of cancer‐specific patient health portal usage among patients with cancer: results from the UWCCC Survivorship Program

“…Cancer diagnoses and treatment are complicated, and patients and caregivers must often assist in managing their cancer care. 3,5,[7][8][9] Portals are a tool that may help patients with chronic diseases such as cancer undertake such care-related work. [13][14][15] T A B L E 2 Predictors of the portal account status and usage by patients with cancer messaging, although the overall volume of any messages was low.…”

“…Patients with cancer are often challenged by such complex self-management tasks and may lack tools or resources for addressing this cancer care-related work. 3,[5][6][7][8][9] The patient health portal ("portal") is an information technology tool that may help patients with cancer manage cancer care-related work. A portal integrates with, or is tethered to, a healthcare system's electronic health record (EHR) to support patients with managing their health.…”

“…Patients with cancer are often challenged by such complex self‐management tasks and may lack tools or resources for addressing this cancer care‐related work. 3 , 5 , 6 , 7 , 8 , 9…”

What is known about the role of rural-urban residency in relation to self-management in people affected by cancer who have completed primary treatment? A scoping review

“…Rural residents tend to have higher cancer mortality than urban residents [ 28 , 29 ], and people affected by cancer in rural areas are reported to face a range of additional challenges compared with their urban counterparts [ 30 ], including longer travel distances for treatment, limited access to medical care, support services and health and social care facilities [ 31 – 33 ]. Other factors include unmet psychosocial needs [ 30 , 34 ] as well as increased risk for poorer health outcomes [ 35 ], poorer long-term survival [ 36 ] and a lack of relevant information [ 30 ].…”