Laurence J. Heifetz, MD
It was not news to Joseph Unger, PhD, MS, that patients in rural areas had worse oncology outcomes than their urban counterparts. But what did astonish him in his research, presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, was that patients in clinical trials had similar outcomes, regardless of ZIP code. “To our surprise—and it was a surprise— we found very little evidence that outcomes were different between rural and urban patients receiving protocol- directed therapy,” said Unger, an assistant member of the Cancer Prevention Program in the Public Health Sciences Division at Fred Hutchinson Cancer Research Center in Seattle, Washington.
However, beyond clinical trials, some rural clinics are finding ways to successfully raise the level of cancer care for their patients, and methods vary according to the amount of time and other resources available. For example, clinics are finding that systematically calling higher-risk patients to check on them makes a difference. Others are forming alliances with larger urban care centers, which provide expert opinions and consultations via virtual tumor boards and telehealth visits. Although rural clinics may have financial challenges, some of these improvements can be instituted without a large cash outlay.
Rural Care Quality
There are many reasons why rural patients with cancer tend to have worse outcomes. Resources, both financial and human, are stretched. Clinicians and staff do the best they can within time constraints and other limiting circumstances. Rural clinics don’t usually have a variety of cancer specialists on hand, nor are there unlimited support personnel to transport patients for appointments or ways to provide the medications they need at affordable prices.
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