Rural and remote cancer survivor supportive care services: a scoping review

Early Abstract:

Introduction: Improvements in survival, earlier diagnosis, and cancer treatment have increased the number of individuals living with and beyond cancer, frequently accompanied by late and long-term side effects. These cancer survivors require comprehensive supportive care to combat the resultant effects of the disease and its treatment, encompassing the medical, physical, psychological, and social support aimed at the prevention and management of the adverse effects of cancer and its treatment. Rural and remote survivors experience unique challenges that could be supported by supportive care services; however, their access to supportive care is often constrained by factors such as geographic distance and workforce shortages. This reduced access to supportive care contributes to disparities in health outcomes for rural and remote survivors compared with their urban counterparts. This review aimed to identify and describe supportive care interventions for rural and remote cancer survivors, focusing on intervention types and measures of effectiveness, to establish the current evidence base.
Methods: Using Arksey and O’Malley’s methodological framework, we conducted a scoping review searching in MEDLINE, EMBASE, PsychINFO, and CINAHL databases from database inception to June 14, 2024. Eligibility criteria were defined by the Population–Concept–Context (PCC) framework and included studies describing supportive care services (Concept) for adult (≥18 years) rural and remote cancer survivors (Population) in developed countries during the post-treatment phase of survivorship (Context). Supportive care was defined as services aimed at preventing and managing cancer's adverse effects, focusing on rehabilitation, secondary cancer prevention, and survivorship. Identified records underwent de-duplication and were then screened independently at the title/abstract and full-text levels. Articles were included only if they were deemed eligible by two independent reviewers. Data were then charted to characterize the scope of the literature on supportive care services for rural and remote cancer survivors, including study characteristics, intervention components and type (i.e., support group, behavioural, etc.), and reported outcomes and measures utilized to assess efficacy.
Results: Thirty-seven studies published between November 1999 and September 2023 were included. Most studies were randomized controlled trials and nonexperimental studies. Breast cancer survivors were overrepresented, comprising 54% of the study populations. Common supportive care interventions included support groups (n=9), behavioural interventions (n=9), and educational programs (n=7). Methods such as telehealth (54%) and internet-based delivery (19%) were frequently utilized, highlighting their potential to address distance barriers for rural and remote participants. The efficacy of interventions was assessed through both qualitative and quantitative approaches with many different methods of measurement, preventing standardization.
Conclusion: This review highlights the types of supportive care services described for rural and remote cancer survivors and the methods used to evaluate their efficacy. The findings highlight priorities for future research, including expanding beyond breast cancer populations, evaluating digital health approaches in rural contexts, and developing coordinated, stakeholder-informed models of supportive care to improve survivorship outcomes.
Keywords: cancer, oncology, psychosocial, rural, supportive care.