Closing the Rural Cancer Care Gap: Three Institutional Approaches

Abstract

<jats:p> Patients in rural areas face limited access to medical and oncology providers, long travel times, and low recruitment to clinical trials, all of which affect quality of care and health outcomes. Rural counties also have high rates of cancer-related mortality and other negative treatment outcomes. On April 10, 2019, ASCO hosted Closing the Rural Cancer Care Gap, the second event in its State of Cancer Care in America series. The event focused on two aspects of rural cancer care: a review of the major issues and concerns in delivering rural cancer care and a discussion of creative solutions to address rural-nonrural disparities. This article draws from the event and supporting literature to summarize the challenges to delivering high-quality care in rural communities, update ASCO’s workforce data on the geographic distribution of oncologists, and highlight 3 institutional approaches to addressing these challenges in diverse rural settings. The experience of the 3 institutions featured in the article suggests that increasing rural patients’ access to care requires expanding services and decreasing travel distances, mitigating financial burdens when insurance coverage is limited, opening avenues to clinical trial participation, and creating partnerships between providers and community leaders to address local gaps in care. Because the characteristics of rural communities, health care resources, and patient populations are not homogeneous, rural health disparities require local solutions that are based on community needs, available resources, and trusting and collaborative partnerships. </jats:p>

Barriers and Facilitators to Telemedicine: Can You Hear Me Now?

“…Recently, ASCO hosted the Closing the Rural Cancer Care Gap event as part of its State of Cancer Care in America series to address rural-nonrural disparities. 62 Based on the experience from three institutions, they highlighted the following strategies to help reduce the rural cancer care gap: improved access to cancer care, increased clinical trial participation by rural residents, and partnership between health care providers and local community leaders.…”

Qualitative Assessment of Barriers to Rural Health Care in Pennsylvania

“…15 For instance, metropolitan areas have 11.5 oncologists while rural areas have 0.5 oncologists per 1000 square miles. 15 Physician recruitment to rural communities remains challenging, and some have circumvented this by providing rural outreach clinics for specialty care. In Iowa, medical oncologists travel to 77 visiting community clinics in rural areas.…”

“…Geographic dispersal further compounds this problem, with healthcare infrastructure being more spread out in rural areas. 15 For instance, metropolitan areas have 11.5 oncologists while rural areas have 0.5 oncologists per 1000 square miles. 15 Physician recruitment to rural communities remains challenging, and some have circumvented this by providing rural outreach clinics for specialty care.…”

Recommendations on Eliminating Racial Disparities in Multiple Myeloma Therapies: A Step toward Achieving Equity in Healthcare

“…Although only indirectly modifiable by industry, diversity in clinical research staff could be supported by prioritizing recruitment of sites meeting certain diversity criteria or by sponsoring diversity and inclusion training programs and requiring such qualifications for trials investigators. Geographic areas with high density of minority populations overlap, to a meaningful extent, with lower availability of oncology practices and lower socioeconomic status (12). Therefore, recruiting and retaining patients at such sites would involve either providing adequate support to ensure optimal trial compliance in the traditional trial setting or developing innovative approaches of trial conduct such as decentralized trials.…”