Bigger challenges for rural cancer patients

Rural Americans fighting cancer face even more challenges than those who live in more urban areas, including a lack of nearby physicians and treatment, transportation issues, and access to cancer screenings and follow-up care.

That's according to a review article published online with the journal Oncology, a monthly publication.

The article includes information from more than 97 studies to create one, comprehensive article outlining the challenges facing rural cancer patients as well as some solutions, said Mary Charlton, an assistant professor of epidemiology at the University of Iowa and one of the paper's authors.

About one-fifth of the U.S. population resides in rural areas, according to the study, but only about one-tenth of all physicians practice in those areas. That percentage is even lower when it comes to specialists, such as oncologists, the study found.

In Iowa, almost half its population — 1.4 million people — live in a rural area.

According to the American Society of Clinical Oncology's work force analysis, cited in the article, only 3 percent of medical oncologists practice in rural areas and more than 70 percent of counties in the United States lack a medical oncologist.

This produces complications for rural residents with cancer, forcing them to travel long distances for treatments such as radiation or chemo therapy. One Iowa study cited in the paper found that the mean travel time to radiotherapy services was 26 minutes — but patients who live in small rural towns traveled nearly three times longer than urban residents to receive radiotherapy.

'Cancer isn't just one surgery and you're done,' Charlton said. 'Radiation and chemo require multiple visits. There are some instances where you can't get those two treatments in the same city, but patients may need them in the same day and are forced to travel great distances.'

According to the paper, one 2008 study found that people living in large rural towns travel a median of 51 minutes to get to any specialized oncology care, while those in small rural towns can travel 59 minutes.

'Given the high poverty levels in many rural areas, some patients face financial barriers to transportation, including not having enough money for gas or even a car,' the report said.

Rural residents' per capita income nationwide is $7,417 lower than in urban areas, according to the National Rural Health Association. Here in Iowa, data from the U.S. census shows that the median household income for rural residents is $48,496, compared with $55,011 for those in urban areas.

'Rural cancer patients often don't have a good social support network,' Charlton said, adding they can lack access to public transportation and social workers. 'At a big cancer center, they plug you in' with resources.

Rural residents also can lack access to cancer screening services and follow-up services as well, according to the paper.

Studies have shown that rural residents are less likely to receive mammography screening compared with urban residents, while responsibility for follow-up care often falls to local primary care providers, who may lack experience in treating survivors of certain types of cancers.

The review paper also made sure to point to possible solutions, including outreach clinics — where specialists travel to rural areas a certain number of days each month to see patients — and wider use of telemedicine services.

In Iowa, outreach clinics lowered the median driving time to the closest medical oncology clinic from 52 minutes to

19 minutes, according to the paper. The clinics also increased the rate of chemotherapy administration among patients from 10 percent to 24 percent.

Telemedicine, such as teleoncology services — in which primary care doctors and patients can consult via a secure web camera with cancer specialists — and virtual tumor boards — online multidisciplinary meeting — can reduce the burden of traveling, Charlton said.

'Physicians and oncologists really need to think outside the normal way of doing things to make care easier for patients,' she said.