Trekking for treatment: The step too far that we ask of those living with cancer in rural areas
Cancer incidence is on the rise with new estimates showing that 2 in 5 Australians will be diagnosed with cancer by age 85. Patients who live in regional, rural, and remote areas face an additional cancer battle accessing quality and timely healthcare.
Whilst completing my 2022 medical studies in Western Victoria, I met many patients who emphasised the significant impact travelling to metropolitan centres for care had on them and their families. One major issue cited by patients was the lack of understanding regarding the distance travelled to attend appointments, with clinicians thinking patients who lived 5 hours away were ‘just down the road’. Effective cancer treatment requires numerous appointments with different doctors, together with frequent testing and procedures. This is often translated to patients’ appointments being scattered across several days.
Patients and caregivers carry the financial, emotional, and psychological cost of this scattered scheduling. This includes taking on responsibilities for coordinating travel and accommodation, as well as navigating unfamiliar urban environments, hospitals and health systems. This burden is far greater than previously acknowledged, with studies showing rural caregivers experience a reduction in health quality, reduced work productivity, and psychological distress after supporting someone with cancer, with some caregivers shown to experience greater levels of anxiety and depression than the patient themselves.
The construction and maintenance of good therapeutic relationships between patient and clinicians requires a partnership built on a shared understanding of the patients’ circumstances and goals, so that provision of healthcare services aligns with these.
There are many reasons why patient-centred care is not being effectively implemented for rural cancer patients including protocol- driven care such as standardised appointment intervals, and the burden on patients to speak up and voice concerns. For example having to decline appointments due to financial burden. Consequently, care coordination has recently been found to be one of the most poorly implemented facets of patient-centred care amongst cancer patients.
Going forward, clinicians and health system practitioners need to give more consideration to logistical aspects of care for cancer patients from regional, rural, and remote areas. For example, by taking more time to gather social information during initial diagnoses and treatment planning, including home address and travel time, caring arrangements, financial situation, and personal goals/preferences. With this information, tailored treatment plans with flexible options such as telehealth and other arrangements can be implemented, reducing the burden on patients and their families.
Sonya Klimpsch is a final year Deakin Medical student who was a part of the Rural Community Clinical School in 2022 for year 3 of her studies. She is focused on improving healthcare for those in regional, rural, and remote Australians who face significant health disadvantage across their lifetime.