title: Unmet psychological and practical needs of patients with cancer in rural and remote areas of Western Australia.
abstract: BACKGROUND
  The financial and psychological impacts of cancer treatment on patients can be severe. Practical issues, such as childcare, medical supplies and obtaining 'home help' can impose financial strain on patients and their families, and this is often exacerbated by a simultaneous loss of income if a patient is unable to continue employment during treatment, or if family members become full-time carers. These financial difficulties are often more severe for patients from rural regions because cancer services tend to be concentrated in metropolitan areas, requiring rural patients to relocate or undertake lengthy, frequent commutes to access treatment. The needs of rural cancer patients may differ from and exceed those of metropolitan cancer patients. Because of this, it is important to assess the needs of rural and metropolitan populations to develop appropriate, tailored supportive-care interventions. This article compares the unmet supportive-care needs of rural/remote with metropolitan cancer patients in Western Australia (WA), a large and sparsely populated Australian state with a substantial rural and remote population. This article is part of a larger program of research assessing the supportive-care needs of WA cancer patients.
  
  
  METHODS
  Participants were identified through the Western Australian Cancer Registry (WACR) and considered eligible if diagnosed with any type of cancer between 6 months and 2 years previously. A random sample of 2079 potential participants was generated, structured to include all cancer types and geographical areas, and with both sexes randomised within these groups. Following confirmation and exclusion of deceased patients and those patients excluded at the treating doctor's request, 1770 patients were contacted. Participants were asked to complete a demographic questionnaire and the Supportive Care Needs Survey Long Form (SCNS-59). Data from participants who completed and returned both questionnaires were analysed using descriptive statistics and χ(2) tests; and any missing data were addressed through imputation.
  
  
  RESULTS
  Eight hundred and twenty-nine participants (47% response) completed the SCNS-LF59 and 786 (94.8%) completed both questionnaires. Of the 786 respondents, 234 (30%) were from rural areas and 169 (22%) were from remote areas. Among the 15 items with the highest frequency for 'some needs' on the survey, participant needs did not vary by geographical location, with no significant differences found for any of the 15 items. The item for which the greatest, albeit non-significant (p = 0.12) difference was seen, was 'concern about financial situation'. The differences among all other items were not significant (p-values from 0.28 to 0.96). Furthermore, the proportion of participants reporting 'moderate to high need' on these items also did not differ significantly across geographical populations (p-values from 0.13 to 0.91).
  
  
  CONCLUSIONS
  The lack of discrepancy between rural, remote and metropolitan cancer patients' unmet needs provides a positive message regarding the state of WA cancer services and the level of support provided to rural and remote WA residents. Future research should also assess the unmet needs of rural and remote carers and families in comparison with metropolitan carers and families, to ensure that services are well-equipped to meet the needs of all individuals involved in a patient's cancer journey.
authors.affiliation: Cancer Nursing Research Unit, Sydney Nursing School, University of Sydney, Australia. kate.white@sydney.edu.au
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: White
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Roydhouse
authors.forename: Natalie K
authors.initials: NK
authors.lastname: D'Abrew
authors.forename: Paul
authors.initials: P
authors.lastname: Katris
authors.forename: Moira
authors.initials: M
authors.lastname: O'Connor
authors.forename: Laura
authors.initials: L
authors.lastname: Emery
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D012042:Registries; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult