Understanding Symptom Burden in Patients With Advanced Cancer Living in Rural Areas.
Stephanie Gilbertson-White, Yelena Perkhounkova, Seyedehtanaz Saeidzadeh and 3 others
PMID 31225835WHAT IT FOUND
Rural and nonrural patients with advanced cancer had no significant differences in symptom burden over treatment.
Rural patients had lower cancer-related stress at baseline and lower CRP and IL-1β at T3, but this 21-person pilot cannot prove any effect.
Key findings
01Rural and nonrural patients had no statistically significant differences in symptom burden measures at any time point.
02At baseline, rural participants reported lower cancer-related stress than nonrural participants, with total IES scores of 12.5 versus 24.6 (p = 0.06).
03Rural participants had lower mean CRP (2.95 mg/dl) and IL-1β (0.04 pg/dl) than nonrural participants (7.45 and 0.18), with p = 0.07 and p = 0.08.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 21 patients consented and only 10 completed, so comparisons are unstable. The study was not powered to detect differences; the authors used p < 0.1 and did not adjust for multiple comparisons. Patients were recruited only from an academic cancer center, so rural people treated locally may differ. Most participants were Caucasian, and the sample was small and geographically limited. Rurality was dichotomized by residence code, and definitions of rural may misclassify. Dropout was high and linked to disease progression and treatment changes, not just rurality. The cytokine section describes lower IL-1β/IL-1RA in rural participants, but the reported values show the opposite direction.
Declared interests
The article notes NIH extramural and non-U.S. government research support; the supplied text gives no competing-interest declaration or sponsor role in design, analysis, or writing.
The easy way to misread this
Do not conclude that rural patients have worse symptoms or a worse inflammatory profile. The pilot found no significant differences in symptom burden, was underpowered, and the cytokine and stress differences used a liberal p < 0.1 threshold without adjustment for multiple comparisons.