A good description of the causes of the Rural Cancer Gap can be found here.

Photo: Brooke Gully, Millican, TX

Photo: Wade Swenson, Dalton, MN

The Rural Cancer Gap is a multifaceted issue influenced by social, demographic, personal contributors, geographic distribution of services, and additional access challenges, leading to disparities in cancer-related outcomes between rural and nonrural patients.

Social, Demographic, and Personal Contributors

Rural areas are characterized by a population with multiple risk factors predisposing them to poorer cancer outcomes. These factors include higher rates of medical and behavioral risk factors, such as obesity, smoking, and drug use, and lower rates of preventive care and screening. Rural residents often have lower education and income levels, which contribute to disparities in health literacy and cultural trust in the medical system. Such cultural values as stoicism may lead to delays in seeking medical care or skipping routine screenings, exacerbating the risk of cancers associated with modifiable risks and preventive screening modalities like tobacco, HPV, lung, cervical, and colorectal cancers.

Geographic Distribution of Services

The rural healthcare system suffers from being more spread out with fewer generalist and specialist providers, including oncologists and other necessary medical personnel. This leads to fewer hospitals, treatment facilities, and dedicated cancer centers, alongside a more limited infrastructure for support services like laboratories or radiation therapy. A significant factor contributing to these disparities is the uneven geographic distribution of oncologists and other medical specialists, making it difficult for rural patients to access care. Despite a slight increase in the percentage of oncologists practicing in rural areas, it remains disproportionately low compared to the share of the U.S. population living in these areas.

Additional Access Challenges

Rural patients face several additional hurdles beyond the uneven geographic distribution of healthcare services. These include multidisciplinary care needs, with rural hospitals often unable to offer the same level of expertise or types of services available in urban centers. Travel distance and costs also significantly impact rural patients, who must often travel long distances for care, incurring significant financial hardship.

Furthermore, financial burdens and limited health insurance coverage exacerbate the difficulty of accessing care, with rural residents less likely to be covered by employer-sponsored health insurance and more likely to experience financial burdens related to care.

Lastly, rural patients are under-represented in clinical trials, partly due to geographic inaccessibility and eligibility criteria that do not favor the older, more comorbid rural population.