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Arnold School of Public Health

Nearly twenty percent of rural Americans live more than 60 miles from cancer care providers, according to new research

November 11, 2019 | Erin Bluvas,

Every American should have access to lifesaving cancer treatment. However, a recently published study by researchers at the Rural and Minority Health Research Center at the University of South Carolina’s Arnold School of Public Health found that rural populations have to travel further to reach cancer specialists, including medical oncologists, radiation oncologists, cancer surgeons and gynecological oncologists. They also found disparities in areas with higher poverty rates, American Indian and Alaska Native residents, and/or in the South and West regions. The findings are published in Cancer.

“Despite improvements in preventive and treatment opportunities for patients with colorectal and cervical cancers, rural patients are less likely to receive state-of-the-art treatment,” says assistant professor of health services policy and management Peiyin Hung, who led the study.  “In fact, previous studies have associated living in rural areas with cancer diagnosis at a later stage, inappropriate and/or underuse of treatment and poor survival rates.”

While the Healthy People 2020 objectives for reducing colorectal and cervical cancer mortality rates have been met in large urban counties, rural communities have been left behind. These persistent rural-urban disparities in receipt of cancer treatment and cancer mortality rates suggest that rural populations may also have less access to cancer treatment services.

With the present study, the research team analyzed data on physician practice locations from the 2018 Physician Compare survey and information collected in the 2012-2016 American Community Survey – to estimate the driving distance from each residential zip code area to the nearest medical specialists involved in treating colorectal and cervical cancer patients. These specialists included medical oncology, radiation oncology, surgical oncology, general surgery, gynecological oncology and colorectal surgery.

Nearly one in five rural Americans (eight million individuals) live more than 60 miles from a medical oncologist, according to the team’s findings. Disparities increased significantly when looking at proximity to more specialized clinicians, such as colorectal surgeons (i.e., 6.5 miles for urban residents compared to 51.8 miles for their rural counterparts; a nearly eight-fold difference in median travel distance) and gynecologic oncologists (i.e., 8.0 miles for urban versus 59.6 miles for rural; more than seven times longer for rural residents).

For rural residents to reach cancer care specialists (e.g., colorectal surgeon, gynecologic oncologist, surgical oncologist), more than 50 percent had to travel more than 60 miles and more than 10 percent at least two hours. Five percent of rural patients live in more isolated areas, and these 1.7 million Americans must commute as far as 144 miles to reach a medical oncologist.

“Depending on the type of cancer the patient has, this translates to a nearly five-hour, round trip drive everyone month, if not every week or every day, to receive lifesaving treatment,” Hung says.

Areas with a higher poverty rate, American Indian and Alaska Native residents, and/or located in the South and West regions were more likely to be over 60 miles away from these providers. Based on these substantial travel distances required for rural, low-income residents to access treatment, the study team suggests that policy changes be promptly pursued in order to increase access to specialized cancer care for millions of rural residents.

“Residential proximity to cancer specialists is particularly important for vulnerable populations, especially racial minorities and low-income populations, who have disproportionately high rates of diagnosis at an advanced state of disease and high cancer mortality rates,” Hung says. “The maldistributions of cancer care providers across the nation, resulting in patients traveling long distances for cancer care in certain areas, may exacerbate cancer health disparities in these communities.”

Supported by the Federal Office of Rural Health Policy, Health Resources and Services Administration, US Department of Health and Human Services under cooperative agreement U1CRH30539. The information, conclusions, and opinions expressed in this brief are those of the authors and no endorsement by the Federal Office of Rural Health Policy, the Health Resources and Services Administration, or the US Department of Health and Human Services is intended or should be inferred.


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