Digest Commentator: Dr. Violet D'Souza, PhD, MS, MSc, BDS. Research Associate, Faculty of Dentistry, University of Toronto

Background:

Cancer disparity continues to exist worldwide, affecting those with limited access to care, especially those living in rural areas. Compared to those living in urban areas, rural cancer survivors are less informed and experience higher levels of anxiety and distress, non-cancer-related comorbidities, and mortality. The study described the common health information needs of breast, prostate, and colorectal cancer survivors living in rural areas.

Methods:

This cross-sectional study was conducted with breast, prostate, and colorectal cancer survivors who received treatment at the Wake Forest Baptist Comprehensive Cancer Center in North Carolina. Participants were between two to five years post-diagnosis, at least 40 years of age, spoke English, and lived in a small town or rural area. The rurality was defined based the Zip code. The data were collected through a mailed/telephone-administered survey, which included 23 health information needs questions (binary outcomes) on follow-up care topics under eight domains: tests and treatment, side effects and symptoms, emotional and interpersonal needs, health promotion, fertility, occupation, and insurance. A large proportion of the questions were taken from a National Cancer Institute study on health information needs in adult cancer survivors.

Results:

Of the contacted 345 cancer survivors, 170 with complete data were included in the analyses. Of them, 74 had prostate cancer, 69 had breast cancer, and 27 had colorectal cancers. The most common information needs were about side effects and symptoms (58%), health promotion (54%), tests and treatment (41%), decreasing the risk of future cancers (36%), nutrition and diet (30 %), weight (26 %), and physical fitness (25 %). Furthermore, over 25% reported needing more information about symptoms, late and long-term side effects, how to deal with fatigue, and when to seek medical attention. The number of endorsed needs were significantly higher for younger participants, those belonging­­­­ to an ethnic minority, the less educated, and the financially stressed when compared with older participants who were not a member of an ethnic minority, possessed higher levels of education, and were not financially stressed.

Why I like this article:

The findings of this study are valuable given the paucity of literature on rural cancer survivors. Indeed, this is one of the largest studies ever conducted on rural cancer survivors. This study helps to identify vulnerable survivors among those living in rural areas: those with a younger age, lower education, lower income, and ethnic minority members. The side-effect-related questions were endorsed by 20-30% of participants, suggesting their value in exploring the unmet informational needs of cancer survivors. Given the differences in the healthcare system and demographics between the US and Canada, it might be interesting to explore them in Canadian cancer survivors.

Caution:

Even though risk cannot be estimated in cross-sectional studies, the authors of this study used risk ratios as the measure of effects.  

Original article:

Palmer NR, Avis NE, Fino NF, Tooze JA, Weaver KE. Rural cancer survivors' health information needs post-treatment. Patient Educ Couns. 2020;103(8):1606-14.

Journal website: https://www.sciencedirect.com/journal/patient-education-and-counseling/vol/103/issue/8