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Symptom burden among Northern Alberta radiotherapy patients with advanced cancer: mapping needs and gaps

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Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Cross Cancer Institute, 11560 University Ave, Edmonton, Alberta, Canada

    Winter Spence, Sunita Ghosh, Megan Palen, Alex Liska, Vincent Ha & Fleur Huang

  2. University of Alberta, 8440 112 St NW, Edmonton, Alberta, Canada

    Sunita Ghosh & Fleur Huang

  3. Princess Margaret Cancer Centre, 610 University Ave, Toronto, Ontario, Canada

    Rebecca Wong

  4. University of Toronto, 1 King’s College Circle, Toronto, Ontario, Canada

    Rebecca Wong

Authors
  1. Winter Spence
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  2. Sunita Ghosh
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  3. Megan Palen
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  4. Alex Liska
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  5. Vincent Ha
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  6. Rebecca Wong
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  7. Fleur Huang
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Corresponding author

Correspondence to Winter Spence.

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The authors declare that they have no conflict of interest. The authors are in full control of the primary data and will provide if requested.

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Appendix

Appendix

Fig. 1
figure 1

Map of Alberta. Star represents Edmonton. Catchment area for radiation therapy is all the communities north of Edmonton. (Modified from: https://upload.wikimedia.org/wikipedia/commons/b/b5/Alberta_Topo_Labeled_90_ dpi.png; January 2nd, 2020)

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Fig. 2
figure 2

The Edmonton Symptom Assessment System (ESAS-r). (Accessed from: https://www.albertahealthservices.ca/info/Page14546.aspx January 10, 2020)

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Spence, W., Ghosh, S., Palen, M. et al. Symptom burden among Northern Alberta radiotherapy patients with advanced cancer: mapping needs and gaps. Support Care Cancer 28, 4963–4969 (2020). https://doi.org/10.1007/s00520-020-05330-2

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  • DOI: https://doi.org/10.1007/s00520-020-05330-2

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