According to a report from the Centers for Disease Control and Prevention (CDC), Cancer is the second leading cause of death[1] in the United States and is a serious public health issue. The social determinants of health, such as level of education, financial stability, social and community context, and access to healthcare, can affect cancer incidence and mortality rates. Research, data, and medical opinion indicate that a patient’s zip code may impact their healthcare outcome more than their genetic code.[2,3,4,5]
Significant barriers to cancer treatment are faced by millions of Americans living in rural areas, ranging from a lack of specialized resources, including community-based oncologists, and poor support for complex oncology treatments. Improving access to quality cancer care involves providing resources for community-based oncologists, such as training, peer-to-peer learning, telehealth, and financial incentives to increase their presence in rural regions. To ensure that where you live does not determine if you live, the US should leverage digital health solutions that increase access to care for those living in rural areas.
Fewer oncologists means less access for rural patients
Currently, there is a shortage of oncologists practicing in rural areas, with only 11.2% of US oncologists working full-time in these communities.[6] Limited access to specialized care can significantly impact cancer patients in rural areas, as they often have longer wait times for diagnosis and treatments and fewer treatment options. Digital health solutions that can extend care over long distances can help bridge the disparity gap, ensure timely care coordination, and augment care providers in rural areas.
The impact of rural oncology on quality of care
Rural oncologists face many challenges that interfere with their ability to provide quality and timely patient care. These include limited access to specialty drugs and treatments, inadequate reimbursement from insurance companies, difficulty recruiting personnel, low referrals from primary care providers, the difficulty general oncologists have keeping up with the rapid change in cancer treatments, research, and innovations, and an overall lack of awareness about cancer treatments among the public. Additionally, rural communities often experience higher rates of poverty and lower education levels, which can exacerbate diagnosis delays and contribute to non-compliance, and even abandonment, of treatments. All these factors contribute to worse outcomes for patients living in rural areas.[2]
Policy changes that would remove the requirement for direct physician supervision could enable more oncology care to be delivered safely and affordably in the local community and supervised by remote clinicians in a hub-and-spoke model of care. This kind of policy change with aligned compensation and reimbursement, coupled with appropriate telehealth software, can extend the presence of specialists into the community where properly trained oncology nurse practitioners and therapists could manage the daily infusions and treatments for medical and radiation oncologists, respectively.
Accessibility & Support for Community-Based Oncologists
We can address some of the issues faced in rural communities by ensuring rural oncology providers can access the most current cancer treatments, research, and protocols. More equitable reimbursement policies can make it viable for oncologists to continue community practice. Financial resources such as subsidies or grants can allow them to purchase the necessary equipment for diagnosis and treatment. Although specialized training opportunities will enable oncologists to stay up to date on the latest developments in cancer research, a general oncologist can't keep abreast of the entire field of oncology. Oncologists need additional support from professional societies such as the American Society of Clinical Oncology (ASCO) to help them connect with other specialists and share best practices for treating patients living with cancer. Expert peer review can increase confidence in treatments and lead to more effective use of costly resources. Advanced digital technology platforms like Primum make it easy for community-based oncologists to consult sub-specialists working at academic medical centers for patient-specific clinical decision support at the point of care. Primum is free for oncologists to use and can offer personalized, just-in-time education that helps deal with the huge volume of new information in cancer care.A
Involving Patients & Communities
Another important step towards achieving health equity is involving both patient groups and local communities in discussions around improving access to healthcare services. By engaging directly with members of the community who are affected by policy or practice changes, we can better understand the challenges they face when seeking healthcare services such as oncology care. Additionally, by working together with patient advocacy groups, we can ensure that these efforts are grounded in real-world experiences and evidence rather than theoretical models or assumptions about how people might respond to particular policies or initiatives.
It is essential to include patients and their caregivers in managing their cancer. Oncologists can equip patients and primary care providers with cancer survivorship plans, so they know what to expect and how to deal locally with treatment-related issues as they arise.B,C Combined with software that lets patients log their symptoms and clinicians monitor patient performance remotely, survivorship plans enable proactive local care that can avoid costly ER or specialty visits.D,E Moreover, digital oncology support platforms, such as Jasper Health and Wheelhouse, allow patients and their caregivers to access digital tools and receive one-on-one coaching that helps them navigate their cancer care from diagnosis through remission and beyond.F, G
Conclusion
Achieving health equity in rural oncology requires a multifaceted approach involving healthcare providers and patient advocates working together towards common goals, such as increasing access to quality care regardless of where one lives or works. The right mix of remote expertise with local care providers and technology is one way to improve health equity. We can ensure everyone has equal access to cancer treatments regardless of zip code or socioeconomic status if we leverage financial resources and digital health technology, provide specialized training for community-based oncologists, and engage directly with patients. Together, we can ensure that where you live does not determine if you live!
References:
[1] CDC Cancer Statistic Facts & Figures 2020
[2] Invasive Cancer Incidence, 2004-2013, and Deaths, 2006-2015, in Nonmetropolitan and Metropolitan Counties - United States. S Jane Henley, et al.
[3] Rural-Urban Differences in Cancer Incidence and Trends in the United States. Cancer Epidemiol Biomarkers Prev 2018;27:1265-74, W Zahnd, et al.
[4] Centers for Disease Control and Prevention. An Update on Cancer Deaths in the United States
A Virtual curbside consultation software connecting community oncologists to cancer specialists for guidance on complex and unusual cases is available from Primum Health, Inc. (www.primum.co)
BCancer survivorship software is available from Equicare Health (www.equicarehealth.com)
E Patient monitoring software is available from Kaiku Health (www.kaikuhealth.com/)
F Human-led cancer coaching with personalized care reminders can be found at Jasper Health (www.hellojasper.com/)
G Cancer navigation and coaching with supportive team-based care is available from Wheelhouse (www.wheelhousecares.com/)
Corey Zankowski
Corey is Primum's CEO. Prior to leading Primum, he was an accomplished C-Suite executive with 20+ years' experience in the highly competitive oncology medical device industry.
