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Don't Blame Rural Cancer Patients for Their Poorer Health Outcomes

Analysis  |  By Christopher Cheney  
   August 23, 2018

The disparity between rural and urban cancer patients is best explained by differences in access to care, not demographics or lifestyle factors, recent research suggests.

Rural cancer patients generally have worse outcomes than their urban counterparts, and physician leaders seeking to address the disparity should boost access to care rather than focusing on other factors.

A study published this month in JAMA Open Network found similar outcomes between rural and urban patients enrolled in clinical trials, which suggests lack of access to high-quality care in rural areas is the reason for the outcome disparity.

"If rural and urban patients with cancer receiving similar care also have similar outcomes, then a reasonable inference is that the best means by which to improve outcomes for rural patients with cancer may be to improve their access to quality care," the researchers wrote.

The research examined mortality outcomes in 17 groupings of rural and urban cancer patients enrolled in clinical trials. Mortality outcomes between the patients only varied in one grouping, with rural patients experiencing higher mortality for adjuvant-stage estrogen receptor–negative and progesterone receptor–negative breast cancer.

The research featured nearly 37,000 patients from across the country enrolled in clinical trials over a 26-year period. Closely reflecting national demographics, 19.4% of the patients were from rural areas.

Clinical trials were the focal point of the research because they generally provide consistent high-quality care.

"Patients receiving care in this setting are uniformly staged, treated, and followed up under protocol-specific guidelines, reducing the potential influences of inconsistent pretreatment evaluation, care, and post-treatment surveillance," the researchers wrote.

Earlier research demonstrated a significant level of disparity in cancer mortality rates between rural and urban areas, with 180.4 cancer deaths per 100,000 people in rural areas compared to 157.8 cancer deaths per 100,000 in urban areas.

Closing the gap

The JAMA Open Network researchers made five recommendations for physician leaders and healthcare organizations to address the disparity in cancer treatment outcomes between rural and urban patients:

  1. Improve access to affordable health insurance
  2. Expand access to screening and prevention tools
  3. Boost access to oncology specialists
  4. Increase transportation resources for rural patients who travel long distances to access quality care
  5. Adopt innovation care networks to give rural patients access to new treatments and clinical trials

The researchers say two network models for oncology care—one in the United States and another in Australia—could help address the rural-urban cancer care disparity in this country:

  • The National Cancer Institute's National Community Oncology Research Program features access to clinical trials for community investigators and patients.
  • Australia's Regional Cancer Centers of Excellence are designed to offer multidisciplinary care, boost support services, and increase clinical trial participation. This program has improved access to care, with increased treatment of rural patients in their communities.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

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