For years, doctors, public health experts and researchers have known the risk of dying from cancer is substantially higher if a patient lives in a rural area compared to an urban area.
Now, two University of Virginia Cancer Center experts have outlined steps to improve cancer prevention for millions of rural and medically underserved Americans, and improve their access to cutting-edge clinical trials.
“Most of the over 50 comprehensive cancer centers are in urban areas,” said Dr. Linda Duska, referring to the National Cancer Institute-Designated Cancer Centers.
The D.C. region is home to several of those centers.
In addition to U.Va., Virginia Commonwealth University has achieved the designation, as have the Johns Hopkins University and University of Maryland centers in Baltimore. In D.C., Georgetown Lombardi Comprehensive Cancer Center has earned the designation.
Patients in rural areas often are unable to reap the benefits of cancer specialists.
“To see a specialty provider requires a lengthy drive, taking time off work, getting child care, and there are many other socio-economic barriers that limit a patient’s ability to access care,” Duska said.
“We definitely know that the rural population is at significantly increased risk for multiple health care problems — cancer is just one of them,” she added. “Groups of individuals in rural areas are more likely to have diabetes, they’re more likely to be obese, or more likely to have other conditions that in many ways complicate their lack of access to care.”
Goal: Bring specialty care to rural areas
Duska and U.Va. colleague Dr. Kari Ring outlined a plan in the medical journal Gynecologic Oncology they say could ultimately improve cancer care and prevention for more than 75 million people.
“There are ways to bring our specialty care to the rural areas,” Duska said. “Telehealth can be a great opportunity for rural patients, even if they don’t have access to internet.”
While in urban areas, telemedicine makes it possible for patients to see and hear their providers in a video chat.
Duska said in many remote areas, high-speed internet or even cellphone service isn’t an option
“We can accomplish a lot on a telephone,” in terms of screening high-risk patients. “We can collect family histories, which can be very helpful, and provide education — not just for the patients, but providers, as well.”
In urban cancer centers, an at-risk patient would be encouraged to have genetic testing.
“The blood draws can be done locally, once that screening and counseling has been completed on the telephone,” Duska said.
In addition to screening, Duska and Ring are calling for continued efforts to “decentralize” clinical trials, which typically require participation at urban cancer centers.
Nationally, in all settings — urban and rural — only 2% to 8% of Americans diagnosed with cancer enroll in a clinical trial, Duska said, meaning they can’t benefit from the latest novel approaches as they’re being developed and tested.
“There’s a huge explosion right now of treatment opportunities that are targeted to specific mutations in a person’s tumor,” Dusk said. “We’re not just treating a generic tumor, we’re treating your tumor that has a particular mutation.”
As with screening, Duska and Ring are looking for ways to enable rural patients to have access to clinical trials being run at urban comprehensive cancer centers. Currently, some patients have to pay for travel and lodging to participate in a trial.
“So patients don’t have to travel to Charlottesville, for example, for a study,” Duska said. “They could get this study at a local hospital, where they feel a lot more comfortable, and that’s much closer to home.”
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