Systematic review of cancer treatment programmes in remote and rural areas

Abstract

In an attempt to ensure high quality cancer treatment for all patients in the UK, care is being centralized in specialist centres and units. For patients in outlying areas, however, access problems may adversely affect treatment. In an attempt to assess alternative methods of delivering cancer care, this paper reviews published evidence about programmes that have set out to provide oncology services in remote and rural areas in order to identify evidence of effectiveness and problems. Keyword and textword searches of on-line databases (MEDLINE, EMBASE, HEALTHSTAR and CINAHL) from 1978 to 1997 and manual searches of references were conducted. Fifteen papers reported evaluations of oncology outreach programmes, tele-oncology programmes and rural hospital initiatives. All studies were small and only two were controlled, so evidence was suggestive rather than conclusive. There were some indications that shared outreach care was safe and could make specialist care more accessible to outlying patients. Tele-oncology, by which some consultations are conducted using televideo, may be an acceptable adjunct. Larger and more methodologically robust studies are justified and should be conducted. © 1999 Cancer Research Campaign

Community cancer clinics: patients' perspectives

“…In this light, the mandate of offering cancer patients treatment closer to home is important, as it is a way of meeting the growing needs of cancer patients. Thus, efforts to integrate cancer care services and bring them closer to home have resulted in the establishment of community oncology clinic networks as part of organized cancer programs [2,5,6,13]. Such models for cancer care delivery have the potential to increase the access and availability of chemotherapy treatments to individuals living in rural and remote regions of a country.…”

“…Several countries, including Canada, Australia, the U.S. and the U.K., have accepted the challenge of caring for cancer patients and their families closer to their homes, even when they live in communities located a long way from tertiary cancer centers. As a result, community chemotherapy outreach programs have been or are being developed as part of regional cancer care organizations [2,5,6,13]. While the specific outreach models may vary, depending on the demographic characteristics of individual regions, the goal of developing communitybased cancer services is similar.…”

“…Evaluation of such programs is important and can take the form of measuring such indicators as patient census; incidence and prevalence of patient morbidity and mortality; cost effectiveness; and resource utilization [2,5]. While these outcome measures are important components to be considered in program evaluation, another critical aspect to the success of any health care program, which has been largely ignored in the past, however, is patients' perceptions of their care.…”

Broken doctor–patient relationships: why won't they listen?

“…731 While these studies suggest shared outreach care was safe and could make specialist care more accessible (Level III-2), 731 they have focused primarily on provision of treatment services rather than on programs or interventions for providing psychosocial care. Studies have demonstrated some benefits of education and support provided by specialist cancer nurses for patients in rural areas in terms of improved knowledge and psychosocial support (Level IV).…”

Providing cancer services to remote and rural areas: consensus study

“…Internationally, uncertainty about how best to provide cancer services to patients in remote, rural areas has resulted in many different models of care, but very little evidence exists on which is best (Campbell et al, 1999). There is some evidence that centralisation of cancer services may not achieve as good outcomes for patients from the periphery as might be expected from observational studies (Milne et al, 2000).…”