An Overview of the National Cancer Institute's Initiatives to Accelerate Rural Cancer Control Research

Kennedy, Amy E.; Vanderpool, Robin C.; Croyle, Robert T.; Srinivasan, Shobha

doi:10.1158/1055-9965.epi-18-0934

Cited by 43 publications

(39 citation statements)

References 31 publications

(33 reference statements)

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“…Other U.S.-based studies have found that rural survivors report worse health in all domains including distress, many years after their cancer diagnosis [21] and have significantly poorer mental health functioning, higher levels of anxiety and depression, more distress, lower life satisfaction and more emotional problems than their urban counterparts, independent of education and physical functioning [22]. As a result of these findings, addressing rural-urban cancer disparities is now receiving much attention in the U.S. [23], but the applicability of American findings to the Australian context is unclear.…”

Section: Introductionmentioning

confidence: 99%

Differences in the health, mental health and health-promoting behaviours of rural versus urban cancer survivors in Australia

Gunn

Berry

Meng

et al. 2019

Support Care Cancer

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Purpose: People affected by cancer who live in rural Australia experience inferior survival compared to their urban counterparts. This study determines whether self-reported physical and mental health, as well as health-promoting behaviours, also differ between rural and urban Australian adults with a history of cancer. Methods: Weighted, representative population data were collected via the South Australian Monitoring and Surveillance System between 1 January 2010 and 1 June 2015. Data for participants with a history of cancer (n= 4,295) were analysed with adjustment for survey year, gender, age-group, education, income, family structure, work status, country of birth and arealevel relative socioeconomic disadvantage (SEIFA). Results: Cancer risk factors and co-morbid physical and mental health issues were prevalent among cancer survivors regardless of residential location. In unadjusted analyses, rural survivors were more likely than urban survivors to be obese and be physically inactive. They were equally likely to experience other comorbidities (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, arthritis or osteoporosis). With adjustment for SEIFA, rural/urban differences in obesity and physical activity disappeared. Rural survivors were more likely to have trust in their communities, less likely to report high/very high distress, but equally likely to report a mental health condition, both with and without adjustment for SEIFA. Conclusions: There is a need for deeper understanding of the impact of relative socioeconomic disadvantage on health (particularly physical activity and obesity) in rural settings and the development of accessible and culturally appropriate interventions to address rural cancer survivors' specific needs and risk factors.

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Section: Introductionmentioning

confidence: 99%

Differences in the health, mental health and health-promoting behaviours of rural versus urban cancer survivors in Australia

Gunn

Berry

Meng

et al. 2019

Support Care Cancer

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“…Rural populations have typically been underrepresented in research studies. For example, an analysis from the National Cancer Institute found that only 3% of its research focused on rural populations [17]. Some major barriers that prevent rural populations from participating in clinical trials include lack of knowledge about clinical research opportunities, limited transportation to research centers which are typically located at urban academic research institutes [18], lack of childcare during participation, and difficulty in obtaining time off work to participate [19].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy health in POWERMOM participants living in rural versus urban zip codes

Radin

Peters

Ariniello

et al. 2020

J. Clin. Trans. Sci.

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Background: Pregnant women living in rural locations in the USA have higher rates of maternal and infant mortality compared to their urban counterparts. One factor contributing to this disparity may be lack of representation of rural women in traditional clinical research studies of pregnancy. Barriers to participation often include transportation to research facilities, which are typically located in urban centers, childcare, and inability to participate during nonwork hours. Methods: POWERMOM is a digital research app which allows participants to share both survey and sensor data during their pregnancy. Through non-targeted, national outreach a study population of 3612 participants (591 from rural zip codes and 3021 from urban zip codes) have been enrolled so far in the study, beginning on March 16, 2017, through September 20, 2019. Results: On average rural participants in our study were younger, had higher pre-pregnancy weights, were less racially diverse, and were more likely to plan a home birth compared to the urban participants. Both groups showed similar engagement in terms of week of pregnancy when they joined, percentage of surveys completed, and completion of the outcome survey after they delivered their baby. However, rural participants shared less HealthKit or sensor data compared to urban participants. Discussion: Our study demonstrated the feasibility and effectiveness of enrolling pregnant women living in rural zip codes using a digital research study embedded within a popular pregnancy app. Future efforts to conduct remote digital research studies could help fill representation and knowledge gaps related to pregnant women.

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“…Because of these and other challenges in providing cancer care for rural patients and the resulting rural/urban disparities in cancer outcomes, the National Institutes of Health and American Society of Clinical Oncology (ASCO) have made rural cancer care a priority area in recent years. [90][91][92] In our study, stakeholders identi ed the principles of effective teamwork as important facilitators for rural cancer care delivery ( Table 2, Table 3) even if they have not met other members of the "care team". [93][94][95][96][97][98][99][100] Attitudes toward virtual and remote teamwork were more positive among stakeholders who typically work in teams in their current job (e.g., nurses, social workers, public health department employees)…”

Section: Discussionmentioning

confidence: 99%

“…11-13,31−33 Many cancer patients experience barriers to accessing high-quality cancer programs; this is particularly true for rural patients. 34 Rural patients and their caregivers often face a choice between seeking cancer care at a specialized cancer center hundreds of miles away or being treated by local non-specialized providers. These decisions are often based on insurance restrictions, availability of accessible transportation, and word of mouth recommendations from friends and family and rarely incorporate information about quality of care and outcomes.…”

mentioning

confidence: 99%

Applying Implementation and Team Science Principles to Facilitate Cancer Program Implementation in Remote, Under-resourced Areas

Crabtree-Ide

Sevdalis

Bellohusen

et al. 2020

Preprint

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Background: Failed implementation of health programs is common and may contribute to health disparities in resource-poor communities. We aimed to (1) evaluate barriers and facilitators for implementation of cancer survivorship services in rural communities and to (2) identify optimal strategies for successful implementation of survivorship care programs in these settings. Methods: The study design was guided by the Consolidated Framework for Implementation Research (CFIR) and based on the core principles of effective teamwork. We collected qualitative and quantitative data to assess barriers and facilitators to implementation of rural cancer survivorship care (3 focus groups, size 8, 31, and 77). Data were collected using both in-person and web-based approaches (semi-structured interviews, stakeholder surveys, ThinkTank, project online portal, Google Analytics). Stakeholders included cancer survivors, their families and caregivers, local public services administrators, health providers, and allied health-care professionals from rural and remote communities in Upstate New York. Results: Patients reported preferences for cross-region team-based survivorship care and emphasized the importance of including local providers on regional care teams and networks. Synthesis of results was guided by teamwork principles. Most rural patient stakeholders trusted recommendations received from their local providers (n=6, 86%) and preferred receiving care locally (n=6, 86%). Involvement of rural patient navigators (average rank 1.5 out of 5) and county care managers (1.9) was ranked more favorably than reliance on telemedicine alone (3.3) or visiting practice facilitators (3.3). Rural counties that have existing formal and informal networks involved in cancer care scored higher on the metrics of teamwork and demonstrated more advanced readiness to change in regards to survivorship program implementation. Conclusions: Our analysis identified a unique combination of community socio-economic factors, geographic isolation, and limited provider supply common in rural care settings as barriers to optimal delivery of cancer survivorship care in rural settings. We propose teamwork training and facilitation as an innovative implementation strategy to overcome these barriers and minimize their effect on patient access to care. Merging implementation science and team science frameworks could further assist with program adaptation to minimize implementation failure and improve continuity of care for complex cancer pathway management.

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An Overview of the National Cancer Institute's Initiatives to Accelerate Rural Cancer Control Research

Cited by 43 publications

References 31 publications

Differences in the health, mental health and health-promoting behaviours of rural versus urban cancer survivors in Australia

Differences in the health, mental health and health-promoting behaviours of rural versus urban cancer survivors in Australia

Pregnancy health in POWERMOM participants living in rural versus urban zip codes

Applying Implementation and Team Science Principles to Facilitate Cancer Program Implementation in Remote, Under-resourced Areas

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