In Australia, 58% of cancer diagnoses and 76% of cancer mortality is in patients aged >65. Comorbidity increases with age, and both factors affect cancer treatment choices, initiation and outcomes, and health related quality of life (HRQoL). Rurality also impacts these experiences, however despite emerging evidence, rural geriatric oncology populations are underrepresented in available studies. This study therefore aims to determine the prevalence of physical comorbidities among this cohort, and to study the relationship between comorbidity, rurality, treatment process and outcomes, and HRQoL.
The study includes patients aged >65, with any solid tumour diagnosis, attending a regional cancer centre. Quantitative data was obtained using validated tools to examine HRQoL, comorbidities, and clinical parameters, with analysis of predictor variables to quantity association with comorbidity and rurality. Qualitative data was obtained via focus groups with patient, caregiver and health professional cohorts, with thematic analysis undertaken using iterative coding.
Qualitative data highlighted factors influencing diagnosis and treatment, including: difficulty/cost of travel; and other impacts of living in a regional location. Diagnosis delay/complication and emotional aspects were identified as key to cancer experiences, and in HRQoL. Preliminary analysis of quantitative data collected to date (n=110) complements this, with 57% of patients classified as living in outer regional Australia, and 24% as inner regional. Around 30% had at least one comorbidity. A significant relationship does appear between rurality, comorbidities, and HRQoL. The relationship with treatment outcomes is less clear.
Preliminary analysis identifies several key challenges to treatment commencement and completion, including financial, logistical and emotional issues. Statistical analysis further indicates that both rurality and comorbidities may negatively impact HRQoL, and treatment commencement/completion. Data collection and analysis is ongoing to end 2020.
Hunter New England Local Health District - Tamworth Rural Referral Hospital.
Tamworth Hospital, Hunter New England Local Health District.
All authors have declared no conflicts of interest.