In April, the American Society or Clinical Oncology (ASCO) hosted their 2nd annual State of Cancer Care in America event, focusing on closing the gap in rural health care. In recent years we have seen huge strides in cancer care and treatment, with cancer death rates down 25% since the early 1990s. However these gains are not universally realized throughout the United States. As Monica M. Bertagnolli, MD, President of ASCO stated “Our zip code, where we live, is a factor that influences whether we get cancer, whether we survive it and if we receive treatment that is successful.”
ASCO outlined four key challenges in in addressing the inequality in rural cancer care. Limited oncology workforce impacts the availability of care, disproportionately fewer oncologists and other cancer care providers are available in rural areas. There are also geographic barriers to cancer treatment and follow up care, patients often travel long distances. It is harder for patients in rural areas to take part in clinical trials, which often offer the best and latest treatment options, due to a lack of clinical trial infrastructure. Finally, insurance obstacles are often complex for rural patients to negotiate. Patients are less likely to have employer-provided health insurance and may not have access to Medicaid or comprehensive individual coverage.
During the briefing, ASCO announced their new task for to address the gap in rural cancer care. Comprised of ASCO Board and committee members, the group identified four critical areas to focus on supporting rural oncologists. Firstly, improving education and training to equip oncologists and other cancer care team members to provide specialized care. Secondly, improving the understanding of the rural workforce needs and expanding access to care providers. Thirdly, investing in tele-oncology by increasing broadband access, reimbursement policies and other solutions for remote care. Finally, more research is necessary to develop understanding of the magnitude of differences between rural and urban environments, and increased access to clinical trials.
Two panel discussions addressed these issues, focusing first on the landscape of rural cancer care, and second on pioneering solutions to improve outcomes. Panelists included:
- Leslie Byatt, CPhT, CCRC, Clinical Research Manager, New Mexico Cancer Care Alliance, New Mexico Minority/Underserved NCORP Grant Administrator
- Hedvig Hricak, MD, PhD, Chair, Department of Radiology, Carroll and Milton Petrie Chair, Memorial Sloan Kettering Cancer Center
- Alan Morgan, MPA, Chief Executive Officer, National Rural Health Association
 Cancer Facts and Figures: Death Rate Down 25% Since 1991; American Cancer Society, Jan. 5, 2017
 Kirkwood MK, Hanley A, Bruinooge SS, et al: The state of oncology practice in America, 2018: Results of the ASCO practice census survey. J. Oncol Pract 14(7): e412-e240,2018.
 (Onega T, Duell EJ, Shi X, et al. Geographic access to cancer care in the U.S. Cancer. 2008;112:909-18.)
 (Fenton L, Rigney M, Herbst RS. Clinical trial awareness, attitudes and participation among patients with cancer and oncologists. Commun Oncol. 2009;6:207-13.)
 (Kaiser Family Foundation, 2014 https://www.kff.org/uninsured/issue-brief/the-affordable-care-act-and-insurance-coverage-in-rural-areas/)