In 2019, cancer was the second leading cause of death in the United States.1 According to a 2020 report from the Centers for Disease Control and Prevention (CDC), the incidence of rural cancer was lower than urban incidences, yet the rural death rate from cancer was higher.2
Persons with cancer in rural America face bigger hurdles to access care. Evidence has shown that in the United States rural communities face many disadvantages compared with urban communities. Higher poverty rates, lack of healthcare insurance, lower educational attainment, a higher elderly population, and lack of access to health services are a handful of factors. Recently, the Veteran’s Administration (VA) estimated that 66% of rural counties do not have an oncologist.
Lack of medical care increases one’s chance of getting cancer or other chronic diseases. People in these rural communities do not get preventive care and cannot get to follow-up care. It has been shown that populations living in rural areas have higher average death rates for all cancer sites combined, compared to populations in urban counties. Rural counties have higher incidence and death rates for cancers associated with smoking (e.g., lung and colorectal, cervical and laryngeal cancers). Incidence of both colorectal and cervical cancers can be decrease by screening.3,4,5,6
In 2017, the CDC published in the Mortality and Morbidity Weekly Report (MMWR) that in rural America there was a slower reduction in cancer deaths compared with urban cancer deaths.7 In 2018, The National Cancer Institute (NCI) Division of Cancer Control and Population Science (DCCPS) funded cancer centers across the country to focus on the rural population. In Texas, MD Anderson Cancer Center, located in Houston, and UT Southwestern Medical Center, located in Dallas, were funded. In the U.S. there are a total of 20 NCI-DCCPS funded cancer centers that focus on rural health. These cancer centers conducted studies on cancer control by collaborating with rural clinics, the Indian Health Service (IHS), and low income and underserved communities, to help establish “comprehensive rural cancer control research”. Some of these groups are still involved in a consortium of centers known as the Impact of COVID-19 on the Cancer Continuum Consortium. As of last year, they have focused on how the pandemic may have affected the continuum of care.8
DCCPS is also focused on cancer and aging. That focus includes population health, access to care, and cancer prevention and control, among other variables. There is also a focus on obesity, smoking, and lack of physical activity. Their overarching goal is to eliminate or reduce the risk of cancer in the rural population. Research is also being geared towards pediatrics and young cancer patients as well as other populations and programs.
Although the cancer centers named above are larger centers and were funded for a specific purpose, there are other cancer centers throughout the U.S. These centers are generally in urban and suburban areas, but there are virtually no cancer centers in rural America. Access to care, lack of oncologists and specialty professions in rural America is a major problem in the diagnosis and treatment of this disease. For instance, in the west Texas region the only cancer centers are in big cities. West Texas is a 108-county region. Cancer patients who need care have to drive to a major city. This may not be feasible due to time, money, and transportation. And usually post-diagnosis means that many patients, in rural areas, need therapy. As stated earlier in this article, lack of access to care is resulting in higher cancer mortality in rural areas versus urban areas.
There is good news. In 2020 DCCPS funded 767 grants valued at 509 million dollars. This year, (2021) they funded 150 new grants. Many of these grants focus on health disparities and rural cancer control.9
Another viable solution that can help rural patients gain access to care and assist general practice physicians in cancer treatment is to incorporate telemedicine and Project ECHO into their communities. The Association for Clinical Oncology states in an article “that while broader access is for the benefit of patients who are immunocompromised, expanded telehealth services will assist historically underserved populations reach health care providers. This includes patients living in rural areas and those who find it difficult to get to appointments because of work, childcare responsibilities, or transportation issues.”10
Currently, the VA has launched a TeleOncology program. Its goal is to increase telehealth access to veterans, especially in rural areas. Memorial Sloan Kettering Cancer Center in New York, the University of Kentucky Markey Cancer Center in Lexington, MD Anderson in Houston, as well as other programs were linked into the program to help their rural patients have better access to oncology care. The National Cancer Institute (NCI) and the Federal Communications Commission (FCC) partnered in a project titled Linking & Amplifying User-Centered Networks through Connected Health (LAUNCH): A Demonstration of Broadband-Enabled Health for Rural Populations in Appalachia. In 2017, the two agencies convened a public-private collaboration that included the University of Kentucky.11
With these programs, and the possibility of telehealth options sticking around post-pandemic, rural cancer patients now have a range of choices to choose from to get the care they need, when they need it.