Health-Promoting Behaviours following Primary Treatment for Cancer: A Rural-Urban Comparison from a Cross-Sectional Study

Cancer survivorship in urban people living with cancer following primary treatment: A secondary analysis of qualitative interview data

PURPOSE

Urban cancer survivors have been shown to have better opportunities for recovery of health and wellbeing than their rural counterparts. Whilst there is a considerable body of evidence that explores urban people with cancers' experiences and outcomes, there is a dearth of research that explicitly explores 'urban cancer survivorship' in its own right. This study aimed to explore cancer survivorship in urban people living with cancer who have completed primary treatment.

METHODS

Secondary analysis of in-depth interview data (n = 18) with adults living with cancer who resided in urban parts of the UK. Data were drawn from a broader study on self-management of people living with cancer. An adapted version of Foster and Fenlon's recovery of health and wellbeing in cancer survivorship framework was used to inform the analysis of the data.

RESULTS

Recovery of health and wellbeing was impacted by a variety of contributory factors, which had a largely positive impact. Access to amenities, social support, travel, and healthcare factors were opportunities for urban cancer survivors, whilst pollution, traffic and a lack of green spaces acted as challenges for health management.

CONCLUSION

This study demonstrated how urban residency acted as both a barrier and a facilitator to recovery of health and wellbeing in urban cancer survivors following the completion of primary treatment. Area of residence should be taken into account by health providers and policymakers supporting cancer survivorship and the views of those with lived experiences should be included in informing future practice.

Implementing the European code of cancer practice in rural settings

Existing evidence often indicates higher cancer incidence and mortality rates, later diagnosis, lower screening uptake and poorer long-term survival for people living in rural compared to more urbanised areas. Despite wide inequities and variation in cancer care and outcomes across Europe, much of the scientific literature explicitly exploring the impact of rurality on cancer continues to come from Australia and North America. The European Code of Cancer Practice or "The Code" is a citizen and patient-centred statement of the most salient requirements for good clinical cancer practice and has been extensively co-produced by cancer patients, cancer professionals and patient advocates. It contains 10 key overarching Rights that a cancer patient should expect from their healthcare system, regardless of where they live and has been strongly endorsed by professional and patient cancer organisations as well as the European Commission. In this article, we use these 10 fundamental Rights as a framework to argue that (i) the issues and needs identified in The Code are generally more profound for rural people with cancer; (ii) addressing these issues is also more challenging in rural contexts; (iii) interventions and support must explicitly account for the unique needs of rural residents living with and affected by cancer and (iv) new innovative approaches are urgently required to successfully overcome the challenges faced by rural people with cancer and their caregivers. Despite equitable healthcare being a key European policy focus, the needs of rural people living with cancer have largely been neglected.

A systematic review on the qualitative experiences of people living with lung cancer in rural areas

PURPOSE

To synthesize the qualitative literature exploring the experiences of people living with lung cancer in rural areas.

METHODS

Searches were performed in MEDLINE, CINAHL, and PsycINFO. Articles were screened independently by two reviewers against pre-determined eligibility criteria. Data were synthesized using Thomas and Harden's framework for the thematic synthesis of qualitative research. The CASP qualitative checklist was used for quality assessment and the review was reported in accordance with the ENTREQ and PRISMA checklists.

RESULTS

Nine articles were included, from which five themes were identified: (1) diagnosis and treatment pathways, (2) travel and financial burden, (3) communication and information, (4) experiences of interacting with healthcare professionals, (5) symptoms and health-seeking behaviors. Lung cancer diagnosis was unexpected for some with several reporting treatment delays and long wait times regarding diagnosis and treatment. Accessing treatment was perceived as challenging and time-consuming due to distance and financial stress. Inadequate communication of information from healthcare professionals was a common concern expressed by rural people living with lung cancer who also conveyed dissatisfaction with their healthcare professionals. Some were reluctant to seek help due to geographical distance and sociocultural factors whilst others found it challenging to identify symptoms due to comorbidities.

CONCLUSIONS

This review provides a deeper understanding of the challenges faced by people with lung cancer in rural settings, through which future researchers can begin to develop tailored support to address the existing disparities that affect this population.

Latent classes of health-promoting lifestyle in breast cancer patients undergoing chemotherapy in China: A cross-sectional survey

AIM

To identify the latent classes of a health-promoting lifestyle and examine the associations of latent class profile with individual characteristics of breast cancer undergoing chemotherapy in China in order to provide some insights and recommendations for targeted and individualized health education of health-promoting lifestyle.

DESIGN

A descriptive cross-sectional survey design was used for this work.

METHODS

A total of 197 patients with breast cancer undergoing chemotherapy recruited from the Breast Cancer Outpatient Chemotherapy Clinic of a Grade 3A hospital were surveyed. Health-promoting lifestyle was measured using the Health Promotion Lifestyle Profile-II: Chinese Version Short (HPLP-IICR). Latent class analysis was used to examine respondents' health-promoting lifestyle patterns. Associations between the latent class membership and individual characteristics were examined using multinomial logistic regression.

RESULTS

Four latent classes were identified: Class 1-Good Nutrition and Poor Physical Activity, Class 2-Poor Health Responsibility and Nutrition, Class 3-Active Health-Promoting Lifestyle, and Class 4-Medium Spiritual Growth and Poor Other Dimensions. Younger respondents and respondents with a higher score in anxiety and depression were more likely to be classified in Class 4 rather than Class 1 or 3. Respondents with low exercise self-efficacy were more likely to be classified in Class 4 than the others. Respondents in Class 4 had more chemotherapy symptom severity and interference, and cases of menopause were fewer in Class 4 rather than Class 3. Those in Class 4 were more likely to have been diagnosed with cancer within 3 months than those in Class 1.