- Cancer is the second leading cause of death in the U.S. behind heart disease.
- Studies have shown that cancer death rates in rural areas are higher compared to urban area rates.
- This is partially due to financial and geographical barriers to care for those in rural areas.
- New groups are working to bring improved cancer care to those in rural areas through the use of new technology and programs.
Over the past two years of the COVID-19 pandemic, as a society, we have rightly been taking a magnifying glass to examine ways in which cultural and economic disparities have created gulfs in healthcare equity across the board in the United States.
One area deserving particular focus is the division between urban metropolitan centers where many of the nation’s leading oncology centers are located and rural communities that face barriers to access for specialized cancer care.
Healthline spoke with a range of experts about what is being done to close that urban-rural divide and make for a more equitable environment for cancer treatment and care nationwide in the decades ahead.
The National Institutes of Health’s (NIH)
For example, they cite “socioeconomic deprivation, limited access to quality healthcare, and risk factors for cancer relative to residents of urban areas” as driving factors.
People who reside in rural areas generally are older, “engage in risky health behaviors,” and show a “lower adherence to preventive care” compared to their suburban and urban peers, according to the NIH.
All of this puts members of these rural communities at higher risk of not just cancer but other chronic diseases as well.
“These health disparities are further exacerbated by the lack of health insurance, shortage of primary care physicians, oncologists and other cancer care specialists,” writes the institute.
They reveal that colorectal and lung cancers occur most frequently in rural communities, with the elevated lung cancer rates attributed to elevated rates of tobacco use in these areas.
Additionally, the death rates for lung, colorectal, pancreatic, and breast cancers (the leading causes of death from cancer) are higher in these rural parts of the country than in urban areas.
Dr. Julie Bauman, MPH, director of the GW Cancer Center, told Healthline the lack of access to major cancer research centers for people who live in rural areas is a pressing issue that doesn’t have a single, easy answer.
“There is no doubt that residing in rural or frontier regions of the United States is associated with reduced cancer screening and risk reduction behaviors, later stage at cancer diagnosis, and poorer oncologic outcomes. The underlying reasons are multiple and complex, with major issues including disparities in health insurance and geographic access,” she said. “Travel to a cancer center of excellence indeed is a major burden, and not just the direct expense of transportation and lodging.”
Bauman explained that the need to travel also exacerbates other concerns such as the “cost of lost work and wages,” which in turn feeds the “financial toxicity of cancer care and decreases the involvement of family and caregivers during the cancer care journey.”
The National Cancer Institute also shows that rural areas see the presence of “fewer primary and specialty care physicians” in addition to a lower number of home and community-based service providers.
While roughly 17 to 20 percent of the nation’s population lives in rural regions, just 3 percent of medical oncologists actually practice in them. A high
“It’s important to recognize that even within developed urban areas, we see ‘deserts’ of cancer care where similar issues apply,” Bauman added. “For example, in the Washington, DC metro area, centers of excellence for oncology care are asymmetrically distributed with low accessibility for poor and vulnerable populations.”
When it comes to the challenge these gaps present for vulnerable populations — whether it be lower socioeconomic status as well as people who are racial or gender minorities — Bauman cited the U.S. Southwest as one vivid example. She recently relocated to Washington, DC for her current role from the University of Arizona Cancer Center, where she served as its deputy director.
Bauman explained that, in those border states, “underserved rural and frontier populations are largely communities of color,” which includes people who are part of “Hispanic and American Indian populations.”
“In the Washington DC metro area, the African American and African immigrant populations are discordantly distributed in healthcare deserts,” she added. “In both settings, low access compounds poor oncologic outcomes.”
While the realities between these disparities are bleak, some clinicians and private and public entities have been devising creative solutions to create a better future for those living with cancer in the U.S.
Earlier this year, two oncology companies — Imagia Cybernetics and Canexia Health — announced a merger to bring better cancer testing capabilities to more people.
The combined company, or Imagia Canexia Health, sees advanced artificial intelligence (AI) insights leveraged from large data sets coupled with bringing liquid biopsy cancer testing capabilities locally in-house to community cancer centers.
The goal is to improve access to locally-based testing and analysis rather than outsourcing these services to major urban centers.
They also aim to create a more cost-effective local testing option to local oncologists and clinicians that will provide results with faster turnaround time.
The company cites data that shows while 85 percent of cancer treatments in the U.S. take place at local hospitals and community cancer centers, a mere 15 percent of patients receive routine screening for targeted treatments that could ultimately improve their health outcomes.
By making way for more localized and efficient screening options to take place in community centers that might not necessarily be in the heart of medical hub cities like Boston or San Francisco, Imagia Canexia Health sees an opportunity to improve outcomes for those living with cancer in rural areas.
The company is currently partnering with 20 hospital systems and research labs, including the University of South Alabama.
Dr. Thuy Phung, a pathologist at the University of South Alabama, is one of the company’s clinician partners. Through her lab, Phung has been working with what was originally just Canexia for over a year, and said she has valued the opportunity to bring what she called “one of the most complex diagnostic tests in medicine” in-house at the university.
Located along the Gulf Coast, the University of South Alabama’s academic medical center serves a racially diverse community of patients, with a large Black population.
Within the greater community of those served, Phung said, comes challenges of economic and racial disparities in terms of healthcare and disease outcomes, with the university’s medical center serving as something of a microcosm of many of the inequities seen at large throughout the country.
Phung told Healthline that being able to provide this kind of advanced cancer testing in-house to those seeking oncology care does more than just “provide data.”
It gives direct access to molecular testing experts like herself, and provides a much more cost-effective approach than having biopsies sent to great distances with longer wait times for those tests to be processed and interpreted. It’s better for the hospital, better for the oncologists who rely on the testing to devise diagnoses and treatment options, and, ultimately, better for what is traditionally an underserved patient population.
Phung said it’s simply just more intuitive to have this kind of testing and processing capabilities internally at a community health center and simplifies the process.
Phung also stressed how important it is that rural areas have the direct access to people with her specialized expertise.
She said there are an estimated 400 molecular pathology experts who are directing labs like hers in the country.
Having someone like Phung on hand locally is a great boon to the physician or oncologist who can consult her on whether it is the correct test, whether their “thinking is on the right path,” she said.
“This is what I’m trained to do,” she added. “That kind of service is very hard to get when using commercial processes with hundreds and hundreds of clients.”
Also, having all of this take place locally saves a lot of money. By having the right test for the right individual, with faster turnaround times, it ultimately trickles down to the patient and their insurance companies themselves, resulting in lower costs.
Geralyn Ochab, Imagia Canexia Health’s CEO, told Healthline that, when it comes to addressing cancer, “time is the only thing you have.” Getting the right treatment at the right time is key, especially when it comes to populations that are already facing greater strain from multiple directions.
When it comes to the feedback her company has received from clinician partners, Ochab said that she’s observed how happy they’ve been to give the patients in their care greater “accessibility to this genomic guided cancer care.”
She said one challenge is getting more oncologists and clinicians — and the healthcare centers they work for — on board. It’s human nature to stick to routines and previously accepted habits. Sometimes getting people to come around to a different way of doing things takes time, but she said it’s worth it.
When asked what is being done today to remove rural cancer care disparities, Bauman cited the “expansion of telemedicine, which accelerated during the pandemic.”
“Although telemedicine does not address the acute cancer journey well, particularly for high intensity treatments that must be delivered on site and under the supervision of a physician — surgery, radiation therapy, and chemotherapy — it can expedite and expand access to initial specialty consultation,” she said. “Telemedicine also works effectively for monitoring care during lower intensity oral treatments and during surveillance and survivorship.”
“A major barrier for realizing greater access to specialty cancer care via telemedicine is the requirement that the physician providing the care must be licensed in the state where the patient resides,” Bauman added.
One company that is embracing modern technology to proliferate inclusive cancer care and support as widely as possible is Alula.
Founded by two-time cancer survivor Liya Shuster-Bier, the company stands as comprehensive online hub for all things cancer care.
You can find resources to useful information, a digital marketplace for all of the cancer care items that you need heading into, or following, your cancer treatment.
The company also offers “Alula On Call,” where you can seek live, real-time support.
Like millions of Americans, Shuster-Bier can pinpoint a time before and after cancer affected her life. It was while she was an MBA student at the Wharton School of the University of Pennsylvania when she said she and her father had to seemingly overnight “earn a PhD” in cancer in helping her mother navigate her early stage breast cancer diagnosis and treatment.
From learning how to administer treatments to discovering the range of “debilitating side effects” caused by her mother’s treatments, Shuster-Bier told Healthline that helping a loved one through cancer required a realm of knowledge that was foreign to her.
Then came her own experience with cancer. A few months after her mother went into remission, Shuster-Bier was diagnosed with aggressive stage II Non-Hodgkin lymphoma.
Her own winding journey with cancer opened her eyes to the fact that, yes, cancer itself can kill you, but “few people realize that treatment itself can lead to ER visits,” which can in turn lead to “extensive hospitalizations that might disqualify you from the next chemotherapy cycle.”
Strange, surprising side effects can appear from treatments and therapies, and even in remission, your body can change in surprising ways.
She said all of this resulted in the founding of Alula.
“The reason I named the business Alula is because ‘the alula’ is the part of the bird’s wing that aids the bird in navigating and landing during turbulent air,” she said. “We all know that cancer treatment is one of the most turbulent flights that you take in medical treatment.”
She said her company aims to serve everyone in all 50 states, and the goal is to especially help close gaps in access and care that exist, especially among underserved communities.
She said she sees her company as one that offers a missing resource, one that she wishes existed when she started her own cancer journey.
Bauman said that “lay patient navigation” is another “growing field” that we should have our eyes on.
“Oncology patient navigators are responsible for holistically supporting patients with cancer as well as their caregivers, with primary focus on overcoming barriers within the healthcare system and facilitating timely and quality access to care through all phases of the cancer journey,” she said.
“Patient navigation can also be delivered via telemedicine. The American Cancer Society
In essence, greater improvements in technological resources can hopefully result in improved patient outcomes and greater health equity.
You shouldn’t have to live in a large metropolitan area to get the best care, receive the best treatment, or clearest diagnosis, Bauman said, adding that telehealth, in all its forms, is a useful tool.
“Technology could be a game changer for symptom management and prevention of emergency room visits. Such applications perform frequent check-ins for patients on cancer treatment, then connect those with alarm symptoms to heightened nurse triage and outpatient management,” Bauman said.
“The frequency and content of the check-in can be tailored to the type and intensity of the treatment as well as the vulnerability of the patient. Programs to enhance digital connectivity for vulnerable populations, including elders, are key to maximizing benefit from this type of technology.”
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