Cross Cancer Institute, 11560 University Ave, Edmonton, Alberta, Canada.
University of Alberta, 8440 112 St NW, Edmonton, Alberta, Canada.
Support Care Cancer. 2020 Oct;28(10):4963-4969. doi: 10.1007/s00520-020-05330-2. Epub 2020 Feb 7.
Patients with advanced cancer often experience symptoms including pain, nausea, anorexia, fatigue, and depression. High symptom burden can be alleviated by multidisciplinary palliative care (PC) teams practicing symptom-directed management. Patients who are unable to access such services may be at higher risk of increased symptoms and poor outcomes.
A sequential exploratory mixed methods study was performed to explore the burden of symptoms experienced by Northern Alberta patients with advanced cancer. The symptom burden among patients from rural and remote communities was characterized in a retrospective review capturing basic demographic and clinicopathologic information, in addition to patient-reported outcomes. Symptom prevalence was evaluated against the nature and range of supportive care services available. Service accessibility was assessed at community level by surveying health care providers (HCPs) and performing thematic analysis on their responses.
From January 1 to December 31, 2017, 607 outpatients were seen in consultation in an integrated palliative radiotherapy clinic in Edmonton, Alberta. A total of 166 (27.3%) patients resided in Alberta communities designated as rural or remote. Patient-reported symptom prevalence and intensity of scores did not differ significantly between rural/remote and urban populations. Unmet practical needs were flagged significantly more often by patients from rural communities (p = 0.05). HCPs from rural community health centers in Northern Alberta were knowledgeable regarding PC services availability and referral processes within their communities.
Although the symptom burden experienced by patients living with advanced cancer in rural and remote areas of Northern Alberta does not differ significantly from their urban counterparts, and community HCPs are knowledgeable regarding PC services, unmet needs within these communities remain. Continuing support for PC services in rural communities, as well as establishing care pathways for patients from rural populations traveling to urban centers to receive treatment, will help to minimize the unmet needs these patients experience.
晚期癌症患者常出现疼痛、恶心、厌食、乏力和抑郁等症状。多学科姑息治疗（PC）团队通过实施以症状为导向的管理，可以缓解高症状负担。无法获得此类服务的患者可能面临更高的症状加重和不良结局风险。
本研究采用序贯探索性混合方法，旨在探讨加拿大北部晚期癌症患者的症状负担。通过回顾性研究，收集基本人口统计学和临床病理学信息以及患者报告的结局，对农村和偏远社区患者的症状负担进行了描述。评估了症状的流行率与可用支持性护理服务的性质和范围。通过调查卫生保健提供者（HCP）并对其回复进行主题分析，在社区层面评估了服务的可及性。
2017 年 1 月 1 日至 12 月 31 日，在艾伯塔省埃德蒙顿的综合姑息性放疗诊所共为 607 名门诊患者提供了咨询服务。共有 166 名（27.3%）患者居住在艾伯塔省指定为农村或偏远的社区。农村/偏远地区和城市地区的患者报告的症状发生率和严重程度无显著差异。农村社区的患者更频繁地表示存在未满足的实际需求（p=0.05）。来自艾伯塔省北部农村社区卫生中心的 HCP 了解他们所在社区的 PC 服务可用性和转诊流程。
尽管居住在艾伯塔省北部农村和偏远地区的晚期癌症患者的症状负担与城市患者相比无显著差异，且社区 HCP 了解 PC 服务，但这些社区仍存在未满足的需求。继续为农村社区的 PC 服务提供支持，并为前往城市中心接受治疗的农村地区患者建立护理途径，将有助于最大限度地减少这些患者的未满足需求。
