title: Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review.
abstract: OBJECTIVE
  The aim of this study was to describe what is known about levels of morbidity and the experience and needs of people with cancer, and their informal caregivers, living in rural areas.
  
  
  METHODS
  A search of online databases for English language papers describing or assessing the prevalence of psychosocial morbidity or needs in a population of rural or regional cancer patients was employed. The following were excluded: intervention studies, discussion of service delivery, effectiveness of support groups or support via videoconferencing, concentrated on medical outcomes or survival rates, reported differences in the uptake of cancer screening or concentrated on health attitudes or treatment decision making.
  
  
  RESULTS
  There were 37 studies in the review, including 25 quantitative studies (all surveys), 11 of which included a control group of urban patients and 12 qualitative studies. Until recently, most studies had methodological shortcomings. Only two prospective studies were identified, most studies focused on breast cancer and few addressed psychological morbidity. The majority of controlled studies reported worse outcomes for rural patients, who appear to have higher needs in the domains of physical/daily living. This may reflect more limited access to resources, a more self-sufficient lifestyle and personal characteristics, for example, being more stoical and less likely to ask for help. The need to travel for treatment caused many practical, emotional and financial problems for patients and burdened them with additional worry concerning family and work commitments. Some patients reported benefits in sharing experiences with others also forced to stay away from home, but most agreed that staying at home was preferable.
  
  
  CONCLUSIONS
  This review highlights that whilst we are beginning to get some insight into the needs of people with cancer in rural areas, much is still unknown. Population-based, prospective studies including people with heterogeneous cancers from rural and urban settings are needed.
authors.affiliation: Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, NSW, Australia. phyllis.butow@sydney.edu.au
authors.forename: Phyllis N
authors.initials: PN
authors.lastname: Butow
authors.forename: Fiona
authors.initials: F
authors.lastname: Phillips
authors.forename: Janine
authors.initials: J
authors.lastname: Schweder
authors.forename: Kate
authors.initials: K
authors.lastname: White
authors.forename: Craig
authors.initials: C
authors.lastname: Underhill
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
mesh_terms: D017028:Caregivers / Q000523:psychology*; D006301:Health Services Needs and Demand; D006801:Humans; D009369:Neoplasms / Q000523:psychology*; D017063:Outcome Assessment, Health Care; D012424:Rural Population; D012944:Social Support; D014505:Urban Population