title: "Undressing" distress among cancer patients living in urban, regional, and remote locations in Western Australia.
abstract: OBJECTIVE
  People diagnosed with cancer from rural and remote locations may experience heightened distress because of distance from cancer treatment and support services. We examined whether remoteness and other factors are associated with psychosocial distress and explored commonly reported problems among cancer patients in Western Australia (WA).
  
  
  METHODS
  In a cross-sectional study, cancer patients newly referred to a Cancer Council WA Cancer Support Coordinator (CSC) were screened and assessed using the Distress Thermometer (DT) and Problem List (PL) and a standardized form, respectively. The index of remoteness was the Australian Standard Geographical Classification. The association between remoteness, demographic variables, and the frequency of problems endorsed on the PL was analyzed using bivariate analyses and a generalized linear mixed model (GLMM) regression.
  
  
  RESULTS
  Of 1032 patients referred to a CSC, 466 were screened (45.2 %) with complete data available for 441 patients. Patients from remote areas reported fewer problems than patients from urban and regional locations. Increasing remoteness was not associated with higher distress (r = -0.04, p = 0.43). Concerns reported differed by remoteness category and included worry, sadness, fears, finances, transportation, and physical symptoms. More emotional problems were independently associated with higher distress (β = 0.47, p < 0.001), explaining 17.31 % of the variance.
  
  
  CONCLUSIONS
  There is no evidence that increasing remoteness is associated with higher distress. Emotional concerns and physical problems appear to be prevalent among cancer patients irrespective of urban or rural location. Specific concerns detected by distress screening, particularly emotional concerns, may warrant further assessment and targeted referrals.
authors.affiliation: Cancer Council Western Australia, 420 Bagot Road, Subiaco, WA, 6008, Australia. kwatts@cancerwa.asn.au.
authors.forename: Kaaren J
authors.initials: KJ
authors.lastname: Watts
authors.affiliation: Cancer Council Western Australia, 420 Bagot Road, Subiaco, WA, 6008, Australia.
authors.forename: Louise H
authors.initials: LH
authors.lastname: Good
authors.affiliation: Cancer Council Western Australia, 420 Bagot Road, Subiaco, WA, 6008, Australia.
authors.forename: Sandy
authors.initials: S
authors.lastname: McKiernan
authors.affiliation: Department of Consultation Liaison Psychiatry, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Miller
authors.affiliation: School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia.
authors.forename: Moira
authors.initials: M
authors.lastname: O'Connor
authors.affiliation: School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Kane
authors.affiliation: Cancer Council Western Australia, 420 Bagot Road, Subiaco, WA, 6008, Australia.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Kruger
authors.affiliation: Cancer Council Western Australia, 420 Bagot Road, Subiaco, WA, 6008, Australia.
authors.forename: Bree R
authors.initials: BR
authors.lastname: Adams
authors.affiliation: School of Surgery, University of Western Australia, Crawley, WA, 6009, Australia.
authors.forename: Toni
authors.initials: T
authors.lastname: Musiello
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005239:Fear; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*; D012944:Social Support; D013223:Statistics as Topic; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D014505:Urban Population / Q000706:statistics & numerical data*; D014904:Western Australia / Q000453:epidemiology
keywords: Cancer; Distress screening; Oncology; Patients; Psychosocial needs