Background

Patients with advanced cancer report an average of as many as 10 to 12 concurrent physical symptoms, which are associated with poorer functional status and quality of life and higher levels of distress (Eckerblad, Theander, Ekdahl, Jaarsma, & Hellstrom, 2015; Gilbertson-White et al., 2012). Symptom management interventions have largely been developed based on the experiences of people of all stages of disease (Berry et al., 2017; Cooley et al., 2017) or on cancer survivors who have completed treatment with curative intent (Freeman et al., 2015; Kapoor & Nambisan, 2018). In addition, the majority of published research on the symptom experience of patients with advanced cancer has primarily included urban and suburban residents who are receiving treatment at tertiary cancer care centers. Therefore, little is known about the symptom management experience of patients with advanced cancer living in rural areas or for those who are receiving care primarily at community or rural cancer centers. Although the existing literature describing rural–urban differences in the context of cancer care (eg, use of breast-sparing surgeries, sentinel node utilization, use of definitive treatment for prostate cancer) is growing, studies on the management of physical symptoms are limited (Jacobs, Kelley, Rosson, Detrani, & Chang, 2008; Meden, St. John-Larkin, Hermes, & Sommerschield, 2002).