Cancer survivors experience many unique needs throughout their survivorship journey, ranging from anxiety associated with diagnosis, to the physical side effects of treatment, to the financial burden that comes with paying for healthcare expenses on top of existing nonmedical expenses. In 2019, we began working with the Wyoming Cancer Coalition (WYCC) and the Wyoming Department of Health (WDH) to develop their next 5-year cancer plan. During development of the 2021-2025 Wyoming Cancer Plan, the WYCC Survivorship Workgroup noted that a needs assessment to understand the specific physical, emotional and practical needs of Wyoming cancer survivors had never been completed. Collecting local insights into the needs of cancer survivors in Wyoming became a priority for the Workgroup and was essential for informing the direction of future coalition efforts for survivors. 

Shortly after completion of the 2021-2025 Wyoming Cancer Plan, we again partnered with the WYCC and WDH to begin development of the Wyoming Cancer Survivors Needs Assessment. Our work intended to answer two questions:

1. What needs do cancer survivors have in Wyoming?

2. How well are these needs being met by providers and programs in the state?

A mixed-methods approach helps to provide confidence in the evaluation results by seeking to test the findings in multiple ways. It can also help address some of the limitations of using data from only one source. Below is a chronological list of the steps taken to conduct the needs assessment, along with the question we were hoping to answer with each approach:

1. Environmental scan of national websites

   • Question to be answered: What needs do cancer survivors commonly have, and what gaps may exist?

2. Targeted literature review of cancer needs in rural areas

   • Question to be answered: What more can we learn about the needs of cancer survivors who live in rural areas?

3. Survey of WYCC Survivorship Workgroup

   • Question to be answered: How do the national themes relate to Wyoming?

4. Meeting with WYCC Survivorship Workgroup

   • Question to be answered: Where do WYCC Survivorship Workgroup members have support to pursue activities around meeting survivor needs and providing resources?

5. Key informant interviews with healthcare and non-profit sector leaders

   • Question to be answered: Based on the experience of key stakeholders in Wyoming, what are the most pressing needs for cancer survivors?

6. Survivor survey

   • Question to be answered: What are the experiences of cancer survivors in Wyoming?

By the time the survey closed, 225 cancer survivors from around the state had participated. Respondents were mainly insured, college-educated, white females. Forty-four percent of respondents reported having breast cancer, followed by 10% with blood cancer (leukemia/ lymphoma) and 9% with gynecological cancer (e.g., cervical, uterine, ovarian). Most were married, and the vast majority had health insurance. The demographics of the respondents also were not representative of the general population of the state, as there were a disproportionate number of women who participated compared to men, and their insurance rates and education levels tended to be higher than the state average. While these results may not be generalizable to everyone, we believe they are an important first step toward examining the needs of many cancer survivors in the state.

Community contexts are crucial to consider when designing data collection tools and processes and communication and dissemination plans. Wyoming’s primary distinction is its rurality, which can make soliciting online survey responses from the general population challenging, as many Wyomingites do not have reliable access to high-speed internet. 

After considering survey responses and outcomes from each of the data collection methods listed above, our analysis identified five key findings:

1. Expanding access to financial, mental health, and care coordination resources could benefit Wyoming cancer survivors.

2. Survivors may be reluctant to ask for help, and often don’t know where to find it even if they do seek help.

3. Body image, sexual function, and intimacy are concerns for many, but survivors struggle to ask for help and find help.

4. Transportation may be part of a bigger financial problem.

5. WYCC could take on problems it isn't currently equipped to address by expanding its membership.

This needs assessment intended to serve as a launching point for the WYCC's future efforts to eliminate barriers and improve the quality of life of Wyoming cancer survivors, and is still being used to inform coalition efforts during the development of their next 5-year plan (2026-2030).