Symptom Burden Among Northern Alberta Radiotherapy Patients with Advanced Cancer: Mapping Needs and Gaps

In this study, we aimed to describe the symptom burden experienced by patients with advanced cancer, as identified at the time of consultation with an integrated palliative radiotherapy service at our institution, one of only 2 tertiary cancer centers in Alberta, and the largest point of care for cancer services in Northern Alberta. Patient-reported symptom scores and concerns are contextualized, especially among those living in rural and remote communities, by assessing the availability of supportive care services, both within the health system and in the community. Patient access to PC services is also explored. 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. From January 1 to December 31, 2017, 607 outpatients were seen in consultation in an integrated palliative radiotherapy clinic in Edmonton, Alberta. 166 (27.3%) patients resided in Alberta communities designated 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 service availability and referral processes within their communities. 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 travelling to urban centers to receive treatment, will help to minimize the unmet needs these patients experience.