Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle-upon-Tyne NE1 4LP, UK.
Division of Applied Health Sciences, Section of Academic Primary Care; University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
Int J Environ Res Public Health. 2020 Feb 24;17(4):1455. doi: 10.3390/ijerph17041455.
Evidence has shown for over 20 years that patients residing in rural areas face poorer outcomes for cancer. The inequalities in survival that rural cancer patients face are observed throughout the developed world, yet this issue remains under-examined and unexplained. There is evidence to suggest that rural patients are more likely to be diagnosed as a result of an emergency presentation and that rural patients may take longer to seek help for symptoms. However, research to date has been predominantly epidemiological, providing us with an understanding of what is occurring in these populations, yet failing to explain why. In this paper we outline the problems inherent in current research approaches to rural cancer inequalities, namely how 'cancer symptoms' are conceived of and examined, and the propensity towards a reductionist approach to rural environments and populations, which fails to account for their heterogeneity. We advocate for a revised rural cancer inequalities research agenda, built upon in-depth, community-based examinations of rural patients' experiences across the cancer pathway, which takes into account both the micro and macro factors which exert influence on these experiences, in order to develop meaningful interventions to improve cancer outcomes for rural populations.
20 多年来的证据表明，农村地区的患者在癌症治疗方面面临着更差的结果。在发达国家，农村癌症患者的生存不平等现象随处可见，但这一问题仍未得到充分研究和解释。有证据表明，农村患者更有可能因紧急情况就诊而被诊断出癌症，而且农村患者可能需要更长的时间才能因症状寻求帮助。然而，迄今为止的研究主要是流行病学研究，使我们了解了这些人群中发生的情况，但未能解释原因。在本文中，我们概述了当前农村癌症不平等研究方法中存在的问题，即如何构想和检查“癌症症状”，以及倾向于对农村环境和人群采取简化主义方法，而这种方法无法解释其异质性。我们主张制定一个经过修订的农村癌症不平等研究议程，该议程基于对农村患者在癌症治疗过程中的经历进行深入的、基于社区的研究，同时考虑到对这些经历产生影响的微观和宏观因素，以便为改善农村人口的癌症治疗结果制定有意义的干预措施。
