On June 23, 2020, JCO: Oncology Practice published an article on rural cancer care as part of the State of Cancer Care in America series. "Closing the Rural Cancer Care Gap: Three Institutional Approaches," draws from the second event in the State of Cancer Care in America series and supporting literature to summarize the challenges to delivering high-quality care in rural communities, highlight institutional approaches to addressing these challenges, and update ASCO’s rural workforce data.

Roughly 15-19% of the U.S. population live outside of major metropolitan centers, and rural residence has become a predictor for cancer outcomes. The article finds that decreasing rural disparities requires strategies that increase patient access such as:

• Expanding services and decreasing travel distances
• Mitigating financial burdens, particularly when insurance coverage is limited
• Opening avenues to clinical trial participation
• Creating partnerships between providers and community leaders to address local gaps in care

The article reviews three models of successful rural health interventions that reflect individual community needs and available resources:

• Ohio State University Comprehensive Cancer Center (OSUCCC), Center for Cancer Health Equity (CCHE): Focuses on creating community-based coalitions to provide cancer education to populations, which has led to an increase in rural residents participating in OSUCCC clinical trials.
   
• Missouri Baptist Medical Center, Heartland Cancer Research: Sends oncologists from metropolitan areas to rural communities to advise on clinical trial participation, which has led to an increase in trial participation among rural residents.
   
• New Mexico Cancer Care Alliance (NMCCA): Uses a hub-and-spoke model of academic and community partners to bring clinical trials to different areas by centralizing the administrative research support.

The article is accompanied by six commentaries on the topic of rural cancer care. In “Cancer Care in the Rural United States:  A Visitor’s Perspectives from Appalachian Ohio, Pine Ridge South Dakota and Sidney Montana,” Dr. Monica Bertagnolli, Chair of the Association for Clinical Oncology, provides her experience traveling to rural areas during her presidency for the American Society of Clinical Oncology, and details the diversity of need in rural communities.

“When a community has the means to support public services and qualified local practitioners are available, then excellent health care is possible…Local community integration is essential for progress in improving health behaviors and access to care.  Although rural America encompasses a great variety of cultures, each with unique strengths and challenges, one of the advantages of rural society is a tendency for close community ties,” wrote Dr. Bertagnolli in her commentary. 

Other commentaries within the package cover a variety of topics, including the importance of using local expertise to improve rural cancer care outcomes, multilevel approaches throughout the United States to handle rural cancer care disparities, and the important role telehealth has played in rural areas.

Read the full article and the rest of the package on JCO OP. The full list of the accompanying papers includes:

• Closing the Rural Cancer Care Gap: Three Institutional Approaches, Levit et al.
• Leveraging local expertise to improve rural cancer care outcomes using Project ECHO: A response to Levit et al. (in press), Sanjeev Arora
• Cancer Care in the Rural United States:  A Visitor’s Perspectives from Appalachian Ohio, Pine Ridge South Dakota and Sidney Montana, Monica Bertagnolli
• Disruptive Innovation in Rural Cancer Care: Opening the Doors Amid the Pandemic, Susan Dentzer
• Telehealth is a sustainable population health strategy to lower costs and increase quality of cancer care in rural Utah, David Michael Gill
• Rural cancer disparities in the United States: A multilevel framework to improve access to care and patient outcomes, K. Robin Yabroff

Subscribe to the ASCO in Action Newsletter in the member portal to stay up to date on rural health care issues.

Learn more about ASCO’s commitment to rural cancer care and the ASCO Rural Cancer Care Task Force.