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Rural cancer patients undergo less radiation treatment and experience poorer outcomes

Aug 17, 2022

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Recently published research out of VCU Massey Cancer Center demonstrated that cancer patients who live in rural areas experience higher mortality rates than nonrural cancer patients, among those receiving radiation treatment. Patients living in rural areas were also more likely to miss their radiation appointments, especially at the beginning of their treatment.

Unfortunately, patients who live in rural areas have a higher mortality rate than those living in nonrural areas. Given that cancer treatment nonadherence is associated with higher rates of cancer recurrence and survival, a team of cancer researchers — led by Bonny Morris, Ph.D., RN, — set out to see if geographic differences in nonadherence could be contributing to the higher cancer mortality rate observed among rural residents. Nonadherence is classified as missing a treatment appointment. The researchers examined medical records data from 3,000 cancer patients to assess how nonadherence to radiation treatment and overall survival were impacted by characteristics like where a person lives, their age, race and other social and clinical factors.

The study found that rural residence was associated with both radiation treatment nonadherence and poorer overall survival. Rural patients with a treatment delay had the lowest overall survival, compared to both nonrural survivors and rural survivors without delay.

“Not receiving the prescribed radiation treatment plan impacted patients’ chance of survival, especially for patients living in rural areas who miss treatments at the beginning of their treatment course,” Morris said. “The two-year survival rate was 76% for nonrural residents who did not experience a treatment delay versus 27% for rural residents who experienced a treatment delay. The health care system can play an important role, and I would say has an ethical responsibility, to reduce, and better yet, eliminate these disparities through targeted support programs like patient navigation.”

Study co-author Bernard Fuemmeler, Ph.D., M.P.H., associate director for population sciences and Gordon D. Ginder, M.D., Chair in Cancer Research at VCU Massey Cancer Center, said the findings reinforce the cancer center’s mission to promote health equity by understanding the gaps in cancer care and care delivery to better serve the community. Massey’s catchment area consists of 66 counties and cities, spanning a variety of rural and nonrural communities in the eastern, central and southern portions of Virginia.

“Our data stress the importance for cancer centers across the country with similar catchment areas to identify and attend to the needs of the rural populations they serve,” Fuemmeler said.

Along with rural residents, the research showed that widowed patients, advanced stage cancer patients and lung cancer patients were more likely to be nonadherent to radiation therapy. The study authors suggest that radiation treatment programs should consider implementing nonadherence risk assessments to understand access barriers for each patient based on a multitude of factors, including geographic residence, marital and employment status, cancer type, disease stage and treatment delay. Additionally, they suggest that services such as patient navigation and referrals to social work or financial counselors should be routinely offered to support treatment adherence, particularly for rural patients who are delayed in starting radiation.

Morris reports that her background as someone who grew up in a rural area as well as her clinical background as an oncology nurse helped her to design this study. While a doctoral student at the VCU School of Medicine, she was awarded an F99/K00 fellow award through the National Cancer Institute (F99CA245799), which is a predoctoral-postdoctoral transition award that funded the present study. She is now a postdoctoral fellow at Wake Forest University School of Medicine and in the K00 phase of this award, which will allow her to further her research on how to improve adherence among rural patient populations (K00. 

Collaborators on this study include Emma Fields, M.D., and Roy Sabo, Ph.D., members of the Developmental Therapeutics research program at Massey; and Ryan Hughes, M.D., radiation oncologist, and Kathryn Weaver, Ph.D., in the Department of Social Sciences and Health Policy at Wake Forest University School of Medicine. This study was also supported by the VCU Massey Cancer Center Biostatistical Shared Resource, and, in part, with funding from NIH-NCI Cancer Center Support Grant (P30 CA016059).

Written by: Ben Bane, Phoebe Dacha and Christine Lee

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