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Rural patients and providers struggle to treat cancer

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Cancer patients in rural areas face additional financial, social and physical barriers to treatment than urban patients.

66 percent of rural counties across the U.S. have no oncologists, according to a 2020 study by the American Society of Clinical Oncology.

Abdalla Sholi, Medical Director of Oncology for UPMC Hillman Cancer Center fears that physicians will soon be unable to meet their patients’ needs.

“Not only in the oncology world. This is also [about] recruiting physicians to come in a rural area for oncology and non-oncology-related [practices]. And that’s pretty much a nationwide thing. So, [experts] really assess that we probably need a few thousand more doctors as oncologists in the country,” said Sholi.

According to Sholi, it takes around 12 years to become a fully certified oncologist in Pennsylvania, which can discourage hopeful physicians.

However, Lisa Davis, director of PA’s Office of Rural Health, said having trained oncologists isn’t enough to breach the gap between patients and providers.

“Medical schools and many of the other clinical training programs are in urban areas. So, providers when they train, are used to training in these larger facilities where they have more advanced equipment, they have more colleagues, they have fewer times where they are on call, and it might be more attractive to be in a more urban area,” said Davis.

Urban hospitals and clinics also see more patients, so they can afford better resources than their rural counterparts, according to Davis.

“These kinds of services are very expensive to have on-site. So, you need to make sure that you have the volume of service to be able to pay to have the actual service,” said Davis.

Davis adds that rural hospitals and clinics tend to service lower-income and less patients – they cannot afford to provide the same care as larger facilities.

“These hospitals traditionally are operating at the margin or in the red. And, they provide very high-quality care, but they also do not have the ability, nor should they necessarily all be providing specialty care,” said Davis.

However, community matters when dealing with a cancer diagnosis. Lindsay Sabik, associate professor and vice-chair for Health Policy and Management Research at University of Pittsburgh Public Health researched disparities in rural cancer treatment. She and her team found that patients with more severe cancers often have to choose between staying near friends and family or traveling long distances for specialized care.

“So, then they’re faced with making a decision between traveling a very far distance and staying away from home to receive surgery in a hospital that has more experience, versus going to a hospital closer to home where they may not do as many of these surgeries each year. But it allows patients to, y’know, stay closer to their families and support networks, not face the high costs and logistical burdens of travel,” said Sabik.

Sabik and her team recommend that treatment centers and legislators work on creating more opportunities for people to stay in their communities for treatment to lessen the already high emotional, physical, and financial costs of cancer care.

As a provider in a rural area, UPMC Hillman’s Abdalla Sholi tries to balance resources and quality of patient care.

“Most of the patients will receive most of their care here locally. And we can still offer them a lot of the phase two or phase three trials. But those investigational trials take a lot of expertise and they are not that common to find. So, you have to go to your big places, to UPMC in Pittsburgh to Hopkins,” said Sholi.

While telehealth programs help patients access care from wherever they are, Sholi said patients in rural areas still need more access.

“Technology in the rural area is kind of limited. A lot of patients do not have a lot of access to internet,” said Sholi.

Sholi said that there are resources available to patients seeking support, such as financial counselors and social workers available at UPMC Hillman.

“A lot of those patients are not aware of the services we could offer them and unless you really ask for them and unless you really come and see us, unless you see your doctors, you’re not going to know what kind of services we could offer you to help you with the treatments,” said Sholi.

For additional cancer treatment resources and support groups, visit the Northeast Regional Cancer Institute, the PA Breast Cancer Coalition, or the Cancer Wellness Center of NEPA.

Isabela Weiss is a storyteller turned reporter from Athens, GA. She is WVIA News's Rural Government Reporter and a Report for America corps member. Weiss lives in Wilkes-Barre with her fabulous cats, Boo and Lorelai.

You can email Isabella at isabelaweiss@wvia.org