How to deliver Cancer care in rural areas?
When a cancerous tumor can be surgically resected, there is often a recommendation to deliver postoperative, or adjuvant chemotherapy to improve cure rates. This needs to be done in a timely fashion, usually within 6 weeks of surgery. This interval is taken as a rough guide to the integrity of the surgical findings, that the site was rendered Cancer Free after surgery. This interval can be eaten up by the time taken for a final pathology report, referral to an Oncologist, additional staging scans, postoperative wound healing, treatment planning, and finally treatment initiation. These steps become even more challenging in the rural areas, when patients have to travel great distances for each step.
Even in the US, particularly in the rural areas, the distances can be a barrier to timely treatment. However, creative approaches can overcome some of these barriers.
I recently returned from an assignment in rural Nebraska, where patients traveled distances of around 100 miles each way. There were three Oncologists to service this area, and they had come up with solutions to overcome this barrier. Instead of requiring the patients to come to them, they developed outreach clinics, and had trained nurses in chemotherapy management and delivery. The Oncologists rotated out to the clinics, and patients needed to come in to the central Center only for Radiation therapy and scans. It appeared to me that patients were able to receive state of the art adjuvant therapy in a timely manner. This article reports that density of Oncologists itself is not a barrier to treatment, but geographic distance is. Modern communication technology, and the medical professionals’ motivation to overcome these barriers have found one solution in this area. The physicians spent a lot of hours on the road, so that the patients don’t have to.
http://jco.ascopubs.org/content/33/28/3177.full
Association Between Geographic Access to Cancer Care, Insurance, and Receipt of Chemotherapy: Geographic Distribution of Oncologists and Travel Distance