Despite a willingness and intention to comply with complex treatment schedules for a life-threatening illness, individual social circumstances for many cancer patients can ultimately preclude them from accepting or completing recommended treatment.
60% of Australians have low levels of health literacy, significantly affecting their ability to understand essential health information, seek appropriate and timely care, make informed decisions or to self-manage health conditions.
Family carer responsibilities for patients can supersede attending to their own health needs, particularly for single parents of young children, older patients caring for a disabled adult child or partner, or those who are the legal guardians of grandchildren.
Those without a partner, living alone, estranged from their family or affected by family violence frequently lack conventional social supports to assist with attending appointments, managing treatment side effects or accomplishing tasks of daily living while unwell.
Pre-existing substance abuse, particularly if undisclosed, can compromise good symptom management and hence treatment adherence.
Low paid workers and those working on a casual basis frequently have inflexible employment conditions, affecting their ability to take time from work to have symptoms investigated or to attend follow-up appointments.
It is recognised that transport logistics can present difficulties in attending treatment and appointments for people living in regional and rural areas, but less frequently acknowledged for some patients living in metropolitan areas. Reliance on public or community transport and travelling several hours to the closest treatment centre challenges even patients with the best of intentions but is further compounded by frailty or co-morbidities resulting in decreased mobility.
Substandard housing that compromises the safety of community workers will deny occupants support services and hence challenge treatment adherence. Homelessness presents additional difficulties.
There are additional layers of complexity when these factors interplay with patients from indigenous or CALD backgrounds.
Case examples will illustrate these issues.