Giving Rural Cancer a Fighting Chance to Reduce the Disparity Divide

Cancer is complicated, challenging and creating gaps of health and healthcare in vulnerable communities. Its presence requires more attention, care, funding, supportive healthcare policies and solutions.

CDC Reports on Rural Inequities

The decrease in cancer rates in the nation creates progress, promise and advancements for cancer research, according to the “Morbidity and Mortality Weekly Report,” released on July 6 by the Centers for Disease Control and Prevention (CDC). However, the Report highlights that there isn’t good news for rural or underserved minority populations, shedding light on the growing disparities and the impact on cancer outcomes and rates. 

According to the report:

• Cancer death rates were higher in rural areas (180 deaths for every 100,000 people) compared to 158 deaths per 100,000 in urban areas.
• Cancer rates fell 1 percent a year in rural America compared with 1.6 percent in urban areas.
• The cancer rates were slightly lower in rural areas with 442 cases per 100,000 than in urban areas of 457 per 100,000. Additionally, rural America has higher rates of several types of cancers linked to tobacco use including lung cancer along with some that screening can prevent such as cervical and colon cancers.

Reducing the Disparity Divide

While the news of the growing disparity divide is no surprise, the CDC identified several strategies for rural providers that can be implemented to close the gaps in the identification of new cancer cases and deaths.  These include the following:

• Promote healthy behaviors, such as preventing tobacco use, encouraging tobacco cessation, and eliminating secondhand smoke exposure. Additionally, individuals should limit excessive exposure to the sun and tanning beds reducing ultraviolet rays.
• Participate in state-level comprehensive coalitions, which can be identified at www.cdc.gov/cancer/nccp. Such coalitions focus on cancer-control programs that include education, screening, prevention, access to care, and pursuing overall good health and support for cancer survivors.

Discovery Zone: 21 Rural Strategic Solutions

Addressing challenges and inequities of rural cancer care require collaborations and partnerships, and there are a plethora of opportunities to explore, assess, optimize and duplicate. These include but aren’t limited to the following:

• Evidence-based interventions in outreach clinics, virtual tumor boards, tele-oncology and telemedicine/telehealth
• Healthcare professionals and family members working together
• Community-level preventive interventions and wellness programs
• Population health research
• Cancer-related research partnership opportunities and funding
• Targeted public-health efforts within public-health departments, working with a broad spectrum of stakeholders
• Provision of culturally appropriate, health literacy information and training
• More focus on recruitment, shared resources and centers of excellence
• Outreach efforts of community health workers serving as liaisons within patient-centered care models
• Utilization of rural community assessment plans (via critical access hospital and public health department) to develop a strategic plan
• Innovation of precision medicine for a personalized map of care covered within Medicare and Medicaid and being incorporated within payer strategies
• Use of resource guides, such as the Guide to Community Preventive Services, as well as many other toolkits found within the Rural Health Information Hub at www.ruralhealthinfo.org.
• Webinars and educational forums within academic centers.
• The National Cancer Institute’s (NCI), Central Highlands Appalachia Leadership Initiative on Cancer (CHALIC), which focuses on HPV vaccination, colorectal cancer screening and cancer surveillance
• NCI-designated cancer centers
• The University of Wisconsin Rural Cancer Disparities Project, which offers educational and outreach materials in the community and in clinical settings via Cancer, Clear & Simple. This program also includes training and support of active facilitators and coordinates ongoing quality improvement.
• Visiting consulting clinics within rural communities
• Specialty focuses on women’s health
• The University of Alabama at Birmingham’s (UAB) Comprehensive Cancer Center (covers a six-state area that includes Alabama, Mississippi, Louisiana, Arkansas, South Carolina and Georgia) received a three-year Health Care Innovations Award (HCIA) from the Centers for Medicare & Medicaid Services (CMS), via a patient navigator program called Patient Care Connect (PCC). Its focus is to support and address access barriers to care and resources while helping with coordinating care.

Rural cancer patients face many challenges in receiving care, including limited availability and access to cancer treatments and a broad spectrum of cancer support providers such as mental and behavioral healthcare providers, social workers, oncologists and palliative care specialists.  There are issues associated with limited broadband access for telehealth/tele-oncology, transportation, financial constraints, lack of family and community support.  There also is limited access to clinical trials, an uncertain future for affordable insurance choices, changing health policy and the Senate Republicans proposed healthcare act.

Specialty Focuses

Available data and research must be used in the fight against cancer, and there needs to be more focus on various aspects of rural America, including:

• Pediatric cancer
• Specific needs of a multi-cultural society and population
• Initiatives to improve services to rural women and their health, specifically obstetric and reproductive health outcomes
• Inclusion of financial incentives and assistance with medical liability insurance (Oregon)
• Enhanced primary obstetric care
• Continuing education and consultation services via the University of Arkansas for Medical Sciences and the Arkansas Medicaid Program
• The University of Texas Medical Branch in Galveston provides multiple off-site clinics and programs for housing, transportation needs, EMR and provision of culturally relevant services.

Services such as these will help establish a pathway of sustainability for families to stay in rural communities now and in the future.   

The voice of rural America was heard in the recent presidential election and now rural health and patient outcomes in the fight against cancer need to change to a national platform. With all of the aforementioned strategies, a focus on healthcare policy will be tested. There is an opportunity for rural and underserved communities to turn the tide of findings in future CDC reporting. 

Bottom-line, with so much at risk for rural, the only thing that should be dying is cancer.