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ASCO task force plans ‘new approaches’ to close rural cancer care gap
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Patients with cancer who reside in rural areas routinely deal with logistical issues that affect their ability to receive treatment, often leading to worse outcomes compared with residents of urban areas, according to panelists at a discussion hosted by ASCO.
The society announced that it will form a task force to address these disparities in care.
“There are people with cancer whose care is affected significantly by where they live, what kind of resources they have, and what kind of doctors they have access to,” Monica M. Bertagnolli, MD, FACS, FASCO, ASCO president, professor of surgery at Harvard Medical School, and associate surgeon at Brigham and Women’s Hospital and Dana-Farber Cancer Institute, said during the discussion, broadcast live on Facebook. “One of the frustrating things is that geography all too often dictates a person’s chance of surviving cancer.”
About 19% of the U.S. population lives in rural areas, but only about 6% or 7% of oncologists have a practice that includes a rural area, Bertagnolli added.
Cancer death rates are higher in rural areas because patients often are diagnosed too late. Rural areas have higher rates of poverty, and residents are more likely to be older and uninsured.
‘A unique situation’
The challenges of access to cancer care are not limited to location.
For example, patients living in cities could face some of the same issues as patients living in rural areas if they do not have health insurance.
“People who live in deep urban areas may not have access to care, either,” Lisa C. Richardson, MD, MPH, director of the division of cancer prevention and control at the CDC, said during the discussion. “There can be 50 hospitals around, but you can’t get in unless you have health insurance.”
However, certain factors make rural areas a unique challenge for the health care industry, according to Alan Morgan, CEO of the National Rural Health Association.
“Rural is not a small version of urban,” Morgan said during the discussion. “It’s a unique health care delivery environment. It’s a place where those most in need of health care services often have the fewest options available. You’ll see comparable data about health disparities in urban areas, but the access to providers makes it a unique situation.”
In addition to the lack of access to an oncologist, some rural parts of the United States do not have cellphone service and Wi-Fi, making newer telehealth technology — which allows for video health consultations and remote patient monitoring — unavailable on a regular basis.
“Our world has evolved but hasn’t done so in all places,” Leslie Byatt, CPhT, CCRC, clinical research manager at New Mexico Cancer Care Alliance, said during the discussion. “I can speak of that in New Mexico specifically. There are a lot of folks who do not have a cellphone, a landline or internet service. ... It’s just not available. We have programs in place where we physically go to the people and have a lunch or [a gathering] to talk about clinical trials and [other health care options] because we can’t expect them to go on the internet or Facebook Live to find their information.”
Finding solutions
One solution cannot fix problems in every rural area, according to the panelists.
“Local problems need local solutions,” Electra D. Paskett, PhD, Marion N. Rowley professor of cancer research in the department of internal medicine at The Ohio State University, said during the discussion. “When we go into communities, we go in as partners and we work with community members because they understand the problems and what causes them. We listen to them to determine how we can help solve their problems.”
Partnering with local churches is a good way to help spread helpful information, such as when a mammography van is going to be in town to provide free mammograms.
Ride-hailing services, including Uber and Lyft, recently launched initiatives to help patients with cancer get to and from treatments free of charge. Last year, Lyft partnered with American Cancer Society to create the Road to Recovery program, which offers patients free rides to treatment. Likewise, Uber launched “Uber Health,” which allows health care providers to order rides for their patients.
Some of these new programs are limited to certain areas of the country, and panelists said expanding them could help solve some issues in rural communities.
Project ECHO, launched by University of New Mexico in 2003, has provided community clinicians with training from specialists to help patients in rural areas.
ECHO — or Extension for Community Healthcare Outcomes — uses video technology to connect medical professionals at major academic health care centers with medical professionals at local clinics or practices. New discoveries and best practices are discussed between all parties. The project has hubs in 46 states.
“Project ECHO really tackles a bunch of problems,” Oliver Bogler, PhD, chief operating officer of the ECHO Institute, said during the discussion. “Knowledge [in health care] is exploding, but the reality is that it is traveling very slowly to the underserved communities. Project ECHO creates learning communities that share expertise with underserved communities, whether those communities are rural or urban.”
During the discussion, ASCO announced the formation of the “Rural Cancer Care Task Force” to focus on improving access to high-quality care in rural areas. The task force will work to train medical professionals in rural settings, address broadband issues and reimbursement policies that may impede telehealth, and develop more research on the magnitude of the difference in health outcomes among patients in rural vs. nonrural communities, and how patients in rural areas can enroll in clinical trials.
“We’ve made notable progress in improving outcomes for many people with cancer, but too many individuals, especially in rural communities, are left behind,” ASCO CEO Clifford A. Hudis, MD, FACP, FASCO, said in a press release. “With this new initiative, ASCO will identify ways to build upon existing efforts while also trying new approaches aimed at improving access to cancer care for patients, no matter where they live.” – by John DeRosier
Disclosures: HemOnc Today could not confirm the panelists’ financial disclosures at the time of reporting.