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1. Unique stressors rural cancer patients face

  • Need to travel for specialist treatment[1-5]
    • Financial strain
      • Accommodation
      • Travel
      • Absence from home (and associated cost of maintaining two residences)
      • Absence from work (and associated loss of income)
      • Incidental relocation expenses (e.g. telephone)
    • Social strain
      • Disruption to family life and traditional social/gender roles
      • Isolation from family, friends and support networks
      • Loss of contact with other cancer patients when returning to rural community
    • Emotional strain
      • Confusion and alienation when in an unfamiliar city
      • Fear that absence from home is a burden for others
    • Practical strain
      • Extensive organisation required to relocate for treatment (e.g. care for animals)
      • Difficulty navigating unfamiliar city and facilities
  • Lack of adequate local medical services e.g. to deal with treatment side effects on returning home, such as lymphodema [1, 5, 6]
  • Lack of information that is relevant to people from rural areas  [1, 5, 7]
  • Cultural and social issues
    • A rural setting presents specific difficulties for the discussion of a cancer diagnosis [3] (e.g. due to stigma)
    • Concerns about privacy/gossip [8-10]