Rural Cancer Control: Bridging the Chasm in Geographic Health Inequity

Henley, S. Jane; Jemal, Ahmedin

doi:10.1158/1055-9965.epi-18-0807

Cited by 34 publications

(30 citation statements)

References 20 publications

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“…These findings serve as a reminder that researchers and oncology care providers cannot simply rely on access to community PCPs to address gaps in care along the cancer care continuum. The results emphasize disparities for rural patients that align with broader scientific discussions including elevated rates of health comorbidities, poverty, and treatment-and travel-related distress when compared to urban counterparts [29], as well as those that affect racial/ethnic minority communities. While the majority of results in this article are similar for rural residing patients and others who traveled ≤30 miles for cancer care, these listed disparities indicate that interventions for rural cancer survivors will need to respond to more complex social dynamics affecting remote patients.…”

Section: Discussionmentioning

confidence: 60%

“…Moreover, previous qualitative findings [27], and current state-level data show that virtually all of New Mexico's counties (32 out of 33) are designated as either "whole" or "partial" primary care Health Professional Shortage Areas [28]. These conflicting evidentiary patterns are significant, as a number of research studies highlight the ways in which care disparities stemming from provider shortages in rural areas contribute to worse cancer care outcomes for underserved patients [16,29].…”

Section: Discussionmentioning

confidence: 98%

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Characterizing Low-Risk Breast and Gynecological Cancer Patients for Transition into an Oncology/Primary Care Coordinated Care Model: Findings from a Survey of Diverse Survivors in a Rural U.S. State

Kano

Chen

Boyce

et al. 2021

Cancers

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We conducted a survey to characterize the key attributes of racial/ethnic and geographically diverse low-risk breast and gynecologic cancer patients. We collected data regarding patients’ access to primary care (PC); compliance with screening recommendations; treatment for comorbidities; logistical barriers to clinic visits; and receipt of survivorship care documentation (SCD). Survey findings informed the development of an oncology/Primary Care Provider (PCP) care coordination intervention to improve care. We distributed a cross-sectional survey among a convenience sample of 150 cancer survivors. Responses were calculated using descriptive statistics and compared based on the distance participants traveled to their appointments at the cancer center (≤30 vs. >30 miles). Of the 150 respondents, 35% traveled >30 miles for follow-up care and 78% reported having one or more comorbid condition(s). PC utilization was high: 88% reported having a PCP, and 91% indicated ≤1 yearly follow-up visit. Participants traveling >30 miles reported higher rates of logistical challenges associated with cancer center visits compared to those traveling ≤30 miles. Nearly half of respondents (46%) had not received SCD. In conclusion, survey studies such as these allow for the systematic assessment of survivor behaviors and care utilization patterns to inform the development of care coordination interventions for diverse, low-risk cancer patients.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 98%

Characterizing Low-Risk Breast and Gynecological Cancer Patients for Transition into an Oncology/Primary Care Coordinated Care Model: Findings from a Survey of Diverse Survivors in a Rural U.S. State

Kano

Chen

Boyce

et al. 2021

Cancers

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“…Other concerns in the rural population include longer commute times, less contact with oncology providers, and a greater likelihood of being uninsured [ 11 , 24 ]. In 2019, 12% to 15% of oncologists worked in rural settings, and 20% of rural Americans lived more than 60 miles from an oncologist [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

The Association of Rural-Urban Inhabitation With Gastric Adenocarcinoma Mortality and Treatment: A Surveillance, Epidemiology, and End Results (SEER)-Based Study

Minhas¹,

Fatima²,

Kommineni³

et al. 2021

Cureus

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BackgroundGastric cancer is one of the most prevalent cancers in the world and the third most common cause of death from cancer. The diagnosis and treatment are often complex and require a multifaceted approach. Hence, appropriate and timely management is essential for better patient outcomes. Our aim was to determine if rural inhabitation affects the mortality of patients with gastric adenocarcinoma. If such an association exists, we propose to ascertain whether this is related to delayed diagnosis, differing tumor characteristics, or treatment inequalities. MethodsThe Cox model was applied to gastric adenocarcinoma cases diagnosed during 2004-2011 in American residents aged 20+ years in the Surveillance, Epidemiology, and End Results (SEER) program to determine the impact of rurality on mortality. Binary logistic regression was used to compare the odds of not receiving surgical treatment for localized tumors between rural and urban areas. It was also used to measure the association of rurality with stage at diagnosis (non-metastatic vs. metastatic). ResultsThere was a significant association of rurality on 5-year mortality [HR 1.14 (1.09-1.20), p < 0.01]. No significant association was observed between rural-urban residency and stage at diagnosis, with an odds ratio (OR) of 0.95 (0.87-1.03), p = 0.21. The median time from diagnosis to any first-course treatment was one month for both rural and urban counties. Rural residents were far more likely not to receive surgical treatment for localized tumors than their urban counterparts [OR 1.70 (1.41-2.05), p < 0.01]. A greater percentage of rural inhabitants had cardia tumors as compared to urban ones, 39.8% vs. 33.8% respectively. Non-cardia tumors were far less likely not to receive surgical treatment (i.e., more likely to receive surgical treatment) than cardia tumors , p < 0.01]. ConclusionsRurality is associated with worse gastric adenocarcinoma mortality. This may be due to a lesser probability of receiving surgical treatment for early-stage disease and differences in the primary site of the tumor between rural and urban counties, but not due to differences in stage at presentation. Future research should focus on improving health care access in rural communities.

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“…Open access past, primarily driven by cancers amenable to primary prevention through screening and early detection. 11 Cancer screening is largely coordinated by primary care providers, but primary care is highly complex and cancer screening activities can be lost amidst the myriad of issues that primary care providers face every day. Multiple studies have examined strategies to improve cancer screening in primary care settings.…”

Section: Meaningmentioning

confidence: 99%

“… 7–10 Rural communities have experienced significantly slower declines in cancer mortality over the past, primarily driven by cancers amenable to primary prevention through screening and early detection. 11 …”

Section: Introductionmentioning

confidence: 99%

Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study

et al. 2021

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ObjectiveTo describe common strategies and practice-specific barriers, adaptations and determinants of cancer screening implementation in eight rural primary care practices in the Midwestern United States after joining an accountable care organisation (ACO).DesignThis study used a multiple case study design. Purposive sampling was used to identify a diverse group of practices within the ACO. Data were collected from focus group interviews and workflow mapping. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. Data were cross-analysed by clinic and CFIR domains to identify common themes and practice-specific determinants of cancer screening implementation.SettingThe study included eight rural primary care practices, defined as Rural-Urban Continuum Codes 5–9, in one ACO in the Midwestern United States.ParticipantsProviders, staff and administrators who worked in the primary care practices participated in focus groups. 28 individuals participated including 10 physicians; one doctor of osteopathic medicine; three advanced practice registered nurses; eight registered nurses, quality assurance and licensed practical nurses; one medical assistant; one care coordination manager; and four administrators.ResultsWith integration into the ACO, practices adopted four new strategies to support cancer screening: care gap lists, huddle sheets, screening via annual wellness visits and information spread. Cross-case analysis revealed that all practices used both visit-based and population-based cancer screening strategies, although workflows varied widely across practices. Each of the four strategies was adapted for fit to the local context of the practice. Participants shared that joining the ACO provided a strong external incentive for increasing cancer screening rates. Two predominant determinants of cancer screening success at the clinic level were use of the electronic health record (EHR) and fully engaging nurses in the screening process.ConclusionsJoining an ACO can be a positive driver for increasing cancer screening practices in rural primary care practices. Characteristics of the practice can impact the success of ACO-related cancer screening efforts; engaging nurses to the fullest extent of their education and training and integrating cancer screening into the EHR can optimise the cancer screening workflow.

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Rural Cancer Control: Bridging the Chasm in Geographic Health Inequity

Cited by 34 publications

References 20 publications

Characterizing Low-Risk Breast and Gynecological Cancer Patients for Transition into an Oncology/Primary Care Coordinated Care Model: Findings from a Survey of Diverse Survivors in a Rural U.S. State

Characterizing Low-Risk Breast and Gynecological Cancer Patients for Transition into an Oncology/Primary Care Coordinated Care Model: Findings from a Survey of Diverse Survivors in a Rural U.S. State

The Association of Rural-Urban Inhabitation With Gastric Adenocarcinoma Mortality and Treatment: A Surveillance, Epidemiology, and End Results (SEER)-Based Study

Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study

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