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Older Cancer Survivors in Rural Areas Forgo Health Care Due to Cost

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Key Points

  • Rural cancer survivors aged 65 or older were 66% more likely to forgo routine follow-up health care and 54% more likely to forgo dental care because of cost, compared with their urban counterparts.
  • Out-of-pocket costs may be significant contributing factors for older rural cancer survivors forgoing follow-up medical care. Older cancers survivors may also have less social and family support compared with their urban counterparts.
  • Raising awareness of rural-urban disparities among older cancer survivors may facilitate referrals to resources to address the financial needs of rural cancer survivors.

Rural cancer survivors aged 65 or older were 66% more likely to forgo routine follow-up health care and 54% more likely to forgo dental care because of cost, compared with their urban counterparts, according to a study by Nynikka Palmer, DrPH, MPH, Post-doctoral Fellow in the Department of Social Sciences and Health Policy at Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues. The study is published in Cancer Epidemiology, Biomarkers & Prevention.

The researchers analyzed data from 7,804 cancer survivors who participated in the National Health Interview Surveys conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention between 2006 and 2010. Of these participants, 3,799 were younger than 65 and 4,005 were 65 or older; 1,642 were from rural areas and 6,162 were from urban areas. About 49% of the participants were aged 18 to 64 and primarily received health insurance from their employers, and some had no health insurance. The remaining 51% were aged 65 and older, with the majority covered by Medicare and supplemental Medicaid or private insurance.

According to the study, in both younger and older cancer survivors, a greater proportion of those residing in rural areas compared with urban survivors were non-Hispanic white (P < .001), less educated (P < .001), had one or more noncancer comorbidities (P < .01), and rated their health as poorer (P < .01).

Contributing Factors for Rural-Urban Disparity in Follow-up Medical Care

The study researchers noted that out-of-pocket costs, such as insurance copays, travel expenses, and lost wages, may be significant contributing factors for older rural cancer survivors forgoing follow-up medical care. Also, since many rural areas are experiencing population loss, especially among young adults looking for better economic opportunities, older survivors may have less social and family support compared with their urban counterparts, making it more difficult to access supportive care services, said the report.

The results of this study, said the researchers, may raise awareness of rural-urban disparities among older cancer survivors and facilitate referrals to resources to address the financial needs of rural cancer survivors.

The study authors reported no conflicts of interest. 

The study was funded by the National Cancer Institute at the National Institutes of Health.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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