Psychosocial well-being and supportive care needs of cancer patients and survivors living in rural or regional areas: a systematic review from 2010 to 2021

Abstract

Purpose To summarise what is currently known about the psychosocial morbidity, experiences, and needs of people with cancer and their informal caregivers, who live in rural or regional areas of developed countries. Methods Eligible studies dating from August 2010 until May 2021 were identified through several online databases, including MEDLINE, EMBASE, PsychINFO, and RURAL (Rural and Remote Health Database). Results were reported according to the PRISMA guidelines and the protocol was registered on PROSPERO (CRD42020171764). Results Sixty-five studies were included in this review, including 20 qualitative studies, 41 quantitative studies, and 4 mixed methods studies. Qualitative research demonstrated that many unique psychosocial needs of rural people remain unmet, particularly relating to finances, travel, and accessing care. However, most (9/19) quantitative studies that compared rural and urban groups reported no significant differences in psychosocial needs, morbidity, or quality of life (QOL). Five quantitative studies reported poorer psychosocial outcomes (social and emotional functioning) in urban cancer survivors, while three highlighted poorer outcomes (physical functioning, role functioning, and self-reported mental health outcomes) in the rural group. Conclusion Recent research shows that rural people affected by cancer have unique unmet psychosocial needs relating to rurality. However, there was little evidence that rural cancer survivors report greater unmet needs than their urban counterparts. This contrasts to the findings from a 2011 systematic review that found rural survivors consistently reported worse psychosocial outcomes. More population-based research is needed to establish whether uniquely rural unmet needs are due to general or cancer-specific factors.

Recovery of Health and Wellbeing in Rural Cancer Survivors Following Primary Treatment: Analysis of UK Qualitative Interview Data

“…The results are consistent with many reports of the positive aspects of rurality, such as high levels of community engagement and support [28] and the high self-efficacy found in the surveys conducted in our wider study [35]. The other factors contributing to the survivorship experience, which was previously found to have an effect on cancer survivors, have been mirrored by these results, and these include social support, practical challenges, access issues, and persistent symptoms [9,18,20,33].…”

“…Pre-existing factors, such as gender and SES, have been shown to affect cancer outcomes and experiences [ 15 , 45 ], and our analysis highlights examples of this. Both personal and environmental factors feed into how people cope and into their cancer-related self-efficacy, and it has been found that rural populations experience higher levels of community support and have generally higher self-efficacies [ 18 , 35 ]. This is reflected by the positive experiences of communities in rural areas in this study, finding that most participants relied on community support to support their coping and self-management skills.…”

“…This research examined the intersection between rurality and cancer survivorship [ 15 , 16 , 17 ]. A focus on rurality is important as internationally, rural populations have a lower rate of survival from cancer and report different experiences with healthcare systems and cancer recovery compared with their urban counterparts [ 9 , 18 , 19 , 20 ].…”

“…There is a consensus within the extant literature that the provision of healthcare services tends to be poorer in rural areas. The logistical difficulties of providing specialist care to smaller, sparse populations and necessitating long-distance travel to larger towns or cities to receive adequate care; increased costs and a lack of resources; a need for higher staff-to-patient ratios and multidisciplinary input; difficulty accessing information; and poor communication and care coordination have all been identified as salient issues for service delivery [ 18 , 19 , 26 , 27 , 28 , 29 , 30 , 31 ]. Consequently, the accessibility to services tends to be lower in rural areas [ 15 , 18 , 19 , 27 , 28 ], and many people rely on informal social support from family and friends rather than formal support [ 19 ].…”

“…However, even taking these factors into account, rural populations have still been found to be 5% less likely to survive cancer, suggesting that it is rurality itself that may confer poorer outcomes [ 15 ]. Rural people with cancer also experience poorer mental health [ 18 , 32 ] as well as diminished physical capabilities, more physical inactivity, and lower functional wellbeing compared with their urban counterparts [ 18 , 20 , 26 ]. Additionally, they are less satisfied with their overall quality of life (QOL) [ 20 ] and more likely to report emotional distress [ 26 ].…”