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

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.

A Patient's Perspective: Bridging the Transition Following Radiation Therapy for Patients with Breast Cancer.

INTRODUCTION: As the number of women surviving breast cancer grows, it becomes increasingly important to investigate their unique psychosocial and physical needs in the post-treatment period. The period of transition from patient to survivor is a time fraught with physical and emotional challenges. This qualitative study was conducted to gain insight into the perspective of breast cancer patients transitioning to survivorship after receiving RT in Alberta. METHODS: Ten patients receiving radiation therapy (RT) for breast cancer in Alberta participated in an open-ended telephone interview two to three weeks following the cessation of treatment. The data was analyzed using a qualitative interpretive phenomenological approach. Data was clustered and categorized, and emerging themes were examined. RESULTS: Though participants reported to be satisfied with the care and information they received, a need for more robust and detailed skin care education was identified. Patients expressed a sense of anxiety around returning to normalcy following RT, and described feeling lonely, and unsure of themselves in the post-treatment period. A post-treatment phone call may allow Radiation Therapists (RTTs) to mitigate the ongoing needs of patients in the period between their last day of treatment and their first follow-up visit. CONCLUSION: This project has given us an opportunity to hear the voice of the patient, thus laying the groundwork to allow for a more patient-centred approach to the transition of care following RT. The data gathered suggests possible areas for development of interventions and supports for breast cancer patients as they transition into survivorship.