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Cancer in Rural America: Improving Access to Care

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.

The Atlantic: Rural America Says Pandemic is “Over”, Least Likely To Continue Precautions

Bright american flag flying high above beautiful sunset over Mississippi river. Symbol for patriotism and peace. Background shows illuminated clouds in the sky, copyspace, no people

In a story for The Atlantic, reporter Olga Khazan touches on rural America’s reluctance to continue taking precautions in the current COVID-19 pandemic. As infections and vaccinations wax and wane, most rural areas have done away with mask mandates or social distancing measures, as most think the pandemic is “over”.

From the story: “According to a recent Atlantic/Leger poll, compared with people in urban or suburban areas, people in rural areas are most likely to feel like things are “back to normal” where they live—45 percent thought so, compared with 30 percent of urbanites and 36 percent of suburbanites. Rural Americans were also the least likely group to say they wished their neighbors would be more cautious about COVID-19.

People in rural areas are also significantly less likely than the other two groups to wear a mask indoors at restaurants and bars, or at work. They were the least likely group to say that their kids are required to wear masks to school or day care. They are also more likely to socialize with friends indoors without masks on: 68 percent said they now do this, compared with 54 percent of urbanites. A typical worker in D.C. might send his kid to preschool in a mask, ride to work on the Metro in a mask, and meet friends for drinks at an outdoor café, just in case. An hour and a half away, a typical worker in Culpeper, Virginia, might spend her day exactly as she would have in 2019.”

With the relaxed attitudes however, come some of the lowest vaccination rates in the country, and the most deaths.

To read the rest of the story on The Atlantic, click here.

SOURCE: www.theatlantic.com, The Rural Blog

KFF: 78% of Public Believe Some Parts of COVID-19 Misinformation

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In a new research report by Kaiser Family Foundation, 78% of adults in America believe or aren’t sure about at least one or more false statements about the current COVID pandemic or vaccines. Breaking it down by news media sites, most of the respondents who also watched Newsmax, One American News, or Fox News believed more misinformation than other respondents who watched different news media.

From the report: “Nearly two-thirds (64%) of unvaccinated adults believe or are unsure about at least half of the eight false statements – more than three times the share of vaccinated adults (19%). Nearly half (46%) of Republicans believe or are unsure about at least half the statements, three times the share of Democrats (14%).

The findings highlight a major challenge for efforts to accurately communicate the rapidly evolving science about the pandemic when false and ambiguous information can spread quickly, whether inadvertently or deliberately, through social media, polarized news sources and other outlets.”

“Larger shares of those who trust COVID-19 information from leading conservative news sources believe misinformation, with nearly 4 in 10 of those who trust Fox News (36%) and One America News (37%), and nearly half (46%) of those who trust Newsmax, saying they believe or are unsure about at least half of the eight false statements.

Whether this is because people are exposed to misinformation from those news sources, or whether the types of people who choose those news sources are the same ones who are pre-disposed to believe certain types of misinformation for other reasons, is beyond the scope of the analysis.”

To read the rest of the report and see the data from Kaiser, click here.

SOURCE: www.kff.org

Happy National Rural Health Day!

From all of us at Rural Health Quarterly, have a happy National Rural Health Day!

Visit www.powerofrural.org to learn more.

Kaiser Health: Rural Obstetric Units in Danger of Closing as Births Decrease

In an investigative story for Kaiser Health News, rural hospitals are having to navigate just how many babies they can deliver to justify keeping their obstetric units amid financial issues and low delivery numbers. As rural facilities close their delivery units, they expand the already sizeable “maternity deserts” in rural America.

From the story: “Some researchers have raised concerns based on their findings that hospitals with few deliveries are more likely to experience problems with those births. Meanwhile, “maternity deserts” are becoming more common. From 2004 to 2014, 9% of rural U.S. counties lost all hospital obstetric services, leaving slightly more than half of rural counties without any, according to a study published in 2017 in the journal Health Affairs. Yet shutting down the obstetrics unit doesn’t stop babies from arriving, either in the emergency room or en route to the next closest hospital. In addition, women may have to travel farther for prenatal care if there’s no local maternity unit.

Clinician skills and confidence suffer without sufficient practice, said Dr. Nancy Dickey, a family physician and executive director of the Texas A&M [University] Rural and Community Health Institute in College Station. So, what is that minimum threshold for baby deliveries? “I don’t have a number for you,” she said.”

To read the rest of the story on Kaiser Health News, click here.

SOURCE: www.khn.org