The journey of regional people living with cancer: an examination of health behaviours and engagement in follow-up care in the post-treatment phase

The journey of regional people living with cancer: an examination of health behaviours and engagement in follow-up care in the post-treatment phase

People living in regional communities are disproportionately impacted by cancer compared to metropolitan people, showing significantly poorer cancer outcomes and survival. Further, it has been established that engagement in follow-up medical care and healthy lifestyle behaviours post-treatment is critical for treatment efficacy, optimal recovery and long-term health and wellbeing. Unfortunately, regional populations generally show poorer health promoting behaviours, although there has been little examination whether this persists following cancer diagnosis and treatment. This thesis provides an in-depth examination of the health-promoting behaviours of regional people living with cancer following diagnosis and treatment and aimed to identify the 'regional' factors driving poorer health behaviours. The thesis comprises four studies, the first being a scoping review of factors associated with health-promoting behaviours in regional populations with chronic health conditions, in order to inform the design of the remaining three studies. Given a paucity of literature within regional cancer populations, this review synthesised evidence from regional populations with any chronic health diagnosis. The scoping review findings provided impetus for the examination of individual characteristics in Study 2, 3 and 4, identifying key gaps within the current literature relating to adherence to long-term medical management in regional chronic health populations. While attitudes and beliefs were of particular interest to researchers, individual characteristics commonly used to distinguish regional populations (including stigma, fatalism, consideration of future consequences, resilience and barriers to help-seeking) and found to influence health help-seeking and preventive health behaviours had not yet been examined for their role in engagement in long-term medical management. Additionally, the importance of receiving information and rationale for ongoing medical management featured prominently in the literature, supporting the novel benefits of examining individual characteristics associated with regional populations in Study 2, 3 and 4, while accounting for key demographic factors (age, gender, income, education) and patient information (receipt of a Survivorship Care Plan).The remaining three studies were part of a larger longitudinal cohort study (Travelling for Treatment) conducted in collaboration with the Cancer Council Queensland. The Travelling for Treatment program recruited regional people living with cancer in Queensland who were required to travel to major centres in order to receive treatment, and who stayed at one of Cancer Council Queensland's residential lodges while accessing cancer care. Studies 2, 3 and 4 of this thesis aimed to a) describe the profile of health-promoting behaviours at the time of attending a major centre to receive cancer care, b) examine how those behaviours changed throughout the 12-month period following care, and c) examine whether individual characteristics commonly associated with regional populations predicted health-promoting behaviours in the post-treatment period. In total, 273 participants completed questionnaire assessments at 3 time points (baseline, 6-months and 12-months) over the year following their visit to major treatment centres. Study 2 revealed that, upon entering initial treatment/care, participants showed poor receipt of information/knowledge about their cancer diagnosis. In terms of health behaviours, participants showed patterns of poor weight management, high rates of hazardous drinking and smoking, poor nutrition, and insufficient physical activity levels. Individual characteristics (including attitudes) played a limited role in explaining health status and health behaviours at baseline. Study 3 results revealed that participants showed small improvements in some health behaviours by 6-months post-treatment/care in a major center, however, participants were unable to maintain or further improve these behaviours long-term and returned to baseline levels by the 12-month time point. With respect to engagement in medical follow-up care, while adherence to follow-up appointments and tests was high, a large proportion of participants failed to adhere to ongoing recommended follow-up treatment. Study 4 findings revealed that, in terms of the factors driving health-promoting behaviours, there were very few consistent predictors of health behaviours. In terms of individual characteristics, stigma and resilience were not predictive of health behaviours, although barriers to help-seeking did negatively predict fruit and vegetable consumption as well as smoking cessation, and fatalism negatively predicted vegetable consumption, exercise and smoking cessation at some time points. Female gender, older age and higher education were drivers of positive engagement in health-promoting behaviours. The findings of this program of research suggest that there is significant room for improvement in the health-promoting lifestyle behaviours of regional people following treatment for cancer. Given the known benefits of positive health behaviours such as physical activity, optimal nutrition, reduced smoking and limited alcohol consumption on cancer outcomes, a greater level of support is required in order to assist regional people to make positive changes and to maintain them long-term. However, individual characteristics often associated with regional populations appeared to drive only some health behaviours, and based on this thesis, do not appear to be of substantial impact in determining the poor health behaviours of regional people living with cancer during the post-treatment period. Thus, intervention aimed at improving engagement in long-term cancer management should focus beyond the individual, to a system- and community-level.