FCRP Policy Statement

One out of every four Americans lives in a rural area (a county with fewer than 2500 residents). Individuals residing in these areas are proportionately older, less economically advantaged, more poorly educated and informed, and less comprehensively insured for health care than those in urban areas. The risk of developing most cancers increases with age. Furthermore, poorly educated and informed individuals often do not practice prevention and early detection behaviors. Therefore, there is a higher incidence of late stage cancer in rural areas.

The needs of cancer patients and their families during treatment include physical care; assessment; symptom management; nutrition, emotional, social, and spiritual support; transportation; financial assistance; information; and community resources (i.e., home care, hospice, chore, and housekeeping services). There are many barriers to treatment for those who are diagnosed with cancer in rural areas. Economic factors have caused many rural hospitals to close their doors. Those which remain open cannot afford the state-of-the-art equipment necessary for the diagnosis and treatment of complex problems such as cancer. Rural hospitals often have difficulty attracting cancer specialists, nurses, and other health care professionals capable of treating the disease. Needed community services such as home care, hospice, and chore and housekeeping services are often unavailable.

Therefore, rural residents often rely heavily on informal care services provided by family and friends. However, informal cancer care often involves a high level of out-of-pocket costs; both the formal costs of medical care and the informal costs represented by income lost by the patient and their primary caregiver. Given that one in six rural residents live in poverty and are often un- or under-insured, they may be financially unprepared for the devastating burdens of cancer and its treatment. Public policy strategies at the local, regional, and federal level are needed so that state-of-the-art, continuing, supportive cancer care is available in rural areas.

Local resources need to be developed and coordinated. Patients and their families need information and assistance to access resources. Rural residents may be accustomed to relying on their families, friends, and neighbors for assistance and may be uncomfortable requesting formal help. Community resources such as home care, hospice, housekeeping, and chore services need to be organized, promoted, and marketed so that they will be utilized by rural residents who have need of them. The information needs of cancer patients and their families need to be addressed within the local community. Agencies such as community centers, Area Agencies on Aging, Cooperative Extension offices, and local health departments could provide information related to cancer at the local level. Support groups need to be established at the local level, so that cancer patients and their families can share their experiences and provide mutual support.

Regionally, links should be established between regional cancer care centers and rural health care services. Initial treatments such as radiation or chemotherapy can be performed at the regional center with supportive care provided by the local health care system. This will increase the continuity of care and decrease the cost to rural residents, since fewer visits to the regional center would be required.

At the federal level, efforts are needed to attract health care professionals to rural areas. Cancer specialists in the rural community are an essential element of continuing supportive care. The use of educational incentives such as scholarships and student loans could greatly increase the number of oncologists, oncology clinical nurse specialists, and other health care professionals with cancer care expertise available to rural communities. Health care reform measures being considered at the federal level should ensure that low income rural residents have access to cancer care services. Treatment and follow-up care should be available to the rural poor free or at a low-cost so that family caregivers are supported to care for the patient without losing their job or causing financial disaster to the family.

From Given, B. A., Given, C. W., & Harlan, A. (1993). Strategies to meet the needs of the rural poor. Submitted to Seminars in Oncology Nursing. Prepared by Kara Schiffman. This research is supported by grant #RO1 CA56338, funded by the National Cancer Institute, entitled Rural Partnership Linkage for Cancer Care, Charles W. Given, PhD, and Barbara A. Given, PhD, Principal Investigators. This research project is a collaborative effort of the Michigan State University Colleges of Nursing and Human Medicine, Department of Family Practice, the Cancer Center at MSU, the MSU/Kalamazoo Center for Medical Studies, and the Kalamazoo Community Oncology Program.