Building bridges between clinic and community: Supporting patients and caregivers living in rural and remote Canada

Reanne Booker

Abstract


Advances in the detection, diagnosis, and treatment of cancer have paralleled signif- icant developments in the understanding of tumour biology, pathophysiology, and genomics. In spite of this, cancer remains the lead- ing cause of death in Canada, with an estimated two in five Canadians expected to be diagnosed with cancer and one in four Canadians expected to die of cancer in their lifetime. Although Canada has a pub- licly funded, universal healthcare system, profound inequities exist across the country. Such inequities are often due to a multitude of intersecting factors. The focus of this paper is to review the impact of rurality on cancer care. People residing in rural and remote regions are known to have reduced access to and availability of cancer care, from prevention through diagnosis, treatment, follow-up, and palliative care. Potential strategies to mitigate the challenges associated with rurality will be discussed, including an overview of the role that nurses can play in addressing the needs of patients in rural regions. Oncology nurses are well suited to help support patients, their loved ones, and healthcare colleagues in rural settings with a view to helping improve equity in access to care, quality of care, and outcomes of care for all Canadians.


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Afshar, N., English, D. R., & Milne, R. L. (2019). Rural-urban residence and cancer survival in high-income countries: A systematic review. Cancer, 125(13), 2172–2184. https://doi.org/10.1002/cncr.32073

Arora, S., & Byers, E. L. (2020). Leveraging local expertise to improve rural cancer care outcomes using Project ECHO: A response to Levit et al. JCO Oncology Practice, 16(7), 399–403. https://doi.org/10.1200/OP.20.00260

Bhatia, S., Landier, W., Paskett, E. D., Peters, K., Merrill, J. K., Phillips, J., & Osarogiagbon, R. U. (2022). Rural-urban disparities in cancer outcomes: Opportunities for future research. Journal of the National Cancer Institute, 114(7), 940–952. https://doi.org/10.1093/jnci/djac030

Booker, R., & Haase, K.R . (2022). Virtual cancer care equity in Canada: Lessons from COVID-19. Clinical Journal of Oncology Nursing, 26(2), 224–227. https://doi.org/10.1188/22.CJON.224-227

Boudreau A. (2019). Practical considerations for the integration of subcutaneous targeted therapies into the oncology clinic. Canadian Oncology Nursing Journal, 29(4), 267–270.

Brenner, D. R., Poirier, A., Woods, R. R., Ellison, L. F., Billette, J. M., Demers, A. A., Zhang, S. X., Yao, C., Finley, C., Fitzgerald, N., Saint-Jacques, N., Shack, L., Turner, D., Holmes, E., & Canadian Cancer Statistics Advisory Committee (2022). Projected estimates of cancer in Canada in 2022. CMAJ, 194(17), E601–E607. https://doi.org/10.1503/cmaj.212097

Brunello, G., Fort, M., Schneeweis, N., & Winter-Ebmer, R. (2016). The causal effect of education on health: What is the role of health behaviors? Health Economics, 25(3), 314–336. https://doi.org/10.1002/hec.3141

Burnett, K., Sanders, C., Halperin, D., & Halperin, S. (2020). Indigenous Peoples, settler colonialism, and access to health care in rural and northern Ontario. Health & Place, 66, 102445. https://doi.org/10.1016/j.healthplace.2020.10244

Canadian Association for Rural & Remote Nursing. (2020). Rural and remote nursing practice in Canada: An updated discussion paper. Canadian Association for Rural & Remote Nursing. www.carrn.com/images/pdf/CARRN_RR_discussion_doc_final_LR-2.pdf

Canadian Cancer Society. (2022). Canadian cancer statistics. A 2022 special report on cancer prevalence. Government of Canada. https://cdn.cancer.ca/-/media/files/research/cancer-statistics/2022-statistics/2022-special-report/2022_prevalence_report_final_en.pdf

Canadian Cancer Society. (2023). Transportation – wheels of hope. Canadian Cancer Society. https://cancer.ca/en/living-with-cancer/how-we-can-help/transportation

Canadian Institute for Health Information. (2022, November 17). A lens on the supply of Canada’s health workforce. www.cihi.ca/en/health-workforce-in-canada-in-focus-including-nurses-and-physicians/a-lens-on-the-supply-of-canadas

Canadian Institute for Health Information. (2023, August 8). A profile of physicians in Canada [infographic]. www.cihi.ca/en/a-profile-of-physicians-in-canada

Canadian Medical Association. (2019a). Quick facts on Canada’s physicians. Canadian Medical Association. www.cma.ca/quick-facts-canadas-physicians

Canadian Medical Association. (2019b). Radiation oncology profile. Canadian Medical Association. www.cma.ca/sites/default/files/2019-01/radiation-oncology-e.pdf

Canadian Medical Association. (2019c). Medical oncology profile. Canadian Medical Association. www.cma.ca/sites/default/files/2019-01/medical-oncology-e.pdf

Carriere, R., Adam, R., Fielding, S., Barlas, R., Ong, Y., & Murchie, P. (2018). Rural dwellers are less likely to survive cancer - An international review and meta-analysis. Health & Place, 53, 219–227. https://doi.org/10.1016/j.healthplace.2018.08.010

Chan, R. J., Milch, V. E., Crawford-Williams, F., Agbejule, O. A., Joseph, R., Johal, J., Dick, N., Wallen, M. P., Ratcliffe, J., Agarwal, A., Nekhlyudov, L., Tieu, M., Al-Momani, M., Turnbull, S., Sathiaraj, R., Keefe, D., & Hart, N. H. (2023). Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature. CA: A Cancer Journal for Clinicians. https://doi.org/10.3322/caac.21788. Advance online publication. https://doi.org/10.3322/caac.21788

Chen, J., Lu, Y., & Kummar, S. (2023). Increasing patient participation in oncology clinical trials. Cancer Medicine, 12(3), 2219–2226. https://doi.org/10.1002/cam4.5150

Chini, C., Bascialla, L., Giaquinto, A., Magni, E., Gobba, S.M., Proserpio, I., Suter, M.B., Nigro, O., Tinelli, G., & Pinotti, G. (2021). Homcology: home chemotherapy delivery in a simultaneous care project for frail advanced cancer patients. Supportive Care in Cancer, 29(2), 917–923. https://doi.org/10.1007/s00520-020-05569-9

Cothran, A., & Martin, J.C. (2022). Hypofractionated radiation: Understanding the modality and impact on patient outcomes. Clinical Journal of Oncology Nursing, 26(1), 23–26. https://doi.org/10.1188/22.CJON.23-26

Coughlin, S.S. (2021). Social determinants of health and cancer survivorship. Journal of Environment and Health Sciences, 7(1), 11–15.

Delgado Guay, M. O., Tanzi, S., San Miguel Arregui, M. T., Chisholm, G., De la Cruz, M. G., & Bruera, E. (2014). Characteristics and outcomes of advanced cancer patients who miss outpatient supportive care consult appointments. Supportive Care in Cancer, 22(10), 2869–2874. https://doi.org/10.1007/s00520-014-2254-8

de Moor, J. S., Williams, C. P., & Blinder, V. S. (2022). Cancer-related care costs and employment disruption: Recommendations to reduce patient economic burden as part of cancer care delivery. Journal of the National Cancer Institute. Monographs, 2022(59), 79–84. https://doi.org/10.1093/jncimonographs/lgac006

Eek, D., Krohe, M., Mazar, I., Horsfield, A., Pompilus, F., Friebe, R., & Shields, A. L. (2016). Patient-reported preferences for oral versus intravenous administration for the treatment of cancer: A review of the literature. Patient Preference and Adherence, 10, 1609–1621. https://doi.org/10.2147/PPA.S106629

Egilsdóttir, H., Jónsdóttir, H., & Klinke, M. E. (2022). Living in rural areas and receiving cancer treatment away from home: A qualitative study foregrounding temporality. Global Qualitative Nursing Research, 9, 23333936221111802. https://doi.org/10.1177/23333936221111802

Frosch Z. A. K. (2022). Where have we been with rural-urban cancer care disparities and where are we headed? JAMA Network Open, 5(5), e2212255. https://doi.org/10.1001/jamanetworkopen.2022.12255

Garcia, M. C., Faul, M., Massetti, G., Thomas, C. C., Hong, Y., Bauer, U. E., & Iademarco, M. F. (2017). Reducing potentially excess deaths from the five leading causes of death in the rural United States. Morbidity and Mortality Weekly Report. Surveillance Summaries, 66(2), 1–7. https://doi.org/10.15585/mmwr.ss6602a

Graboyes, E. M., Chaiyachati, K. H., Sisto Gall, J., Johnson, W., Krishnan, J. A., McManus, S. S., Thompson, L., Shulman, L. N., & Yabroff, K. R. (2022). Addressing transportation insecurity among patients with cancer. Journal of the National Cancer Institute, 114(12), 1593–1600. https://doi.org/10.1093/jnci/djac134

Gruca, T. S., Nam, I., & Tracy, R. (2014). Trends in medical oncology outreach clinics in rural areas. Journal of Oncology Practice, 10(5), e313–e320. https://doi.org/10.1200/JOP.2013.001350

Guiliani, M., & Gospodarowicz, M. (2018). Radiation oncology in Canada. Japanese Journal of Clinical Oncology, 48(1), 22–25. https://doi.org/10.1093/jjco/hyx148

Hanna, T. P., King, W. D., Thibodeau, S., Jalink, M., Paulin, G. A., Harvey-Jones, E., O’Sullivan, D. E., Booth, C. M., Sullivan, R., & Aggarwal, A. (2020). Mortality due to cancer treatment delay: Systematic review and meta-analysis. BMJ, 371, m4087. https://doi.org/10.1136/bmj.m4087

Henley, S. J., Anderson, R. N., Thomas, C. C., Massetti, G. M., Peaker, B., & Richardson, L. C. (2017). Invasive cancer incidence, 2004–2013, and deaths, 2006–2015, in nonmetropolitan and metropolitan counties - United States. Morbidity and Mortality Weekly Report. Surveillance Summaries, 66(14), 1–13. https://doi.org/10.15585/mmwr.ss6614a1

Henley, S. J., & Jemal, A. (2018). Rural cancer control: bridging the chasm in geographic health inequity. Cancer Epidemiology, Biomarkers & Prevention, 27(11), 1248–1251. https://doi.org/10.1158/1055-9965.EPI-18-0807

Infrastructure Canada. (2022, August 11). Rural opportunity, national prosperity: an economic development strategy for rural Canada. Government of Canada. https://ised-isde.canada.ca/site/rural/en/rural-opportunity-national-prosperity-economic-development-strategy-rural-canada

Kenamond, M. C., Mourad, W. F., Randall, M. E., & Kaushal, A. (2022). No oncology patient left behind: Challenges and solutions in rural radiation oncology. Lancet Regional Health. Americas, 13, 100289. https://doi.org/10.1016/j.lana.2022.100289

Kornelsen, J., Khowaja, A. R., Av-Gay, G., Sullivan, E., Parajulee, A., Dunnebacke, M., Egan, D., Balas, M., & Williamson, P. (2021). The rural tax: Comprehensive out-of-pocket costs associated with patient travel in British Columbia. BMC Health Services Research, 21(1), 854. https://doi.org/10.1186/s12913-021-06833-2

Lambert, L. K., Horrill, T. C., Beck, S. M., Bourgeois, A., Browne, A. J., Cheng, S., Howard, A. F., Kaur, J., McKenzie, M., Stajduhar, K. I., & Thorne, S. (2023). Health and healthcare equity within the Canadian cancer care sector: A rapid scoping review. International Journal for Equity in Health, 22(1), 20. https://doi.org/10.1186/s12939-023-01829-2

Leveque, D. (2014). Subcutaneous administration of anticancer agents. Anticancer Research, 34(4), 1579–1586.

Levit, L. A., Byatt, L., Lyss, A. P., Paskett, E. D., Levit, K., Kirkwood, K., Schenkel, C., & Schilsky, R. L. (2020). Closing the rural cancer care gap: Three institutional approaches. JCO Oncology Practice, 16(7), 422–430. https://doi.org/10.1200/OP.20.00174

Lin, C. C., Bruinooge, S. S., Kirkwood, M. K., Olsen, C., Jemal, A., Bajorin, D., Giordano, S. H., Goldstein, M., Guadagnolo, B. A., Kosty, M., Hopkins, S., Yu, J. B., Arnone, A., Hanley, A., Stevens, S., & Hershman, D. L. (2015). Association between geographic access to cancer care, insurance, and receipt of chemotherapy: Geographic distribution of oncologists and travel distance. Journal of Clinical Oncology, 33(28), 3177–3185. https://doi.org/10.1200/JCO.2015.61.1558

Longo, C. J., Fitch, M. I., Loree, J. M., Carlson, L. E., Turner, D., Cheung, W. Y., Gopaul, D., Ellis, J., Ringash, J., Mathews, M., Wright, J., Stevens, C., D’Souza, D., Urquhart, R., Maity, T., Balderrama, F., & Haddad, E. (2021). Patient and family financial burden associated with cancer treatment in Canada: A national study. Supportive Care in Cancer, 29(6), 3377–3386. https://doi.org/10.1007/s00520-020-05907-x

Lopez, M. S., Baker, E. S., Milbourne, A. M., Gowen, R. M., Rodriguez, A. M., Lorenzoni, C., Mwaba, C., Msadabwe, S. C., Tavares, J. H., Fontes-Cintra, G., Zucca-Matthes, G., Callegaro-Filho, D., Ramos-Martin, D., Thiago de Carvalho, I., Coelho, R., Marques, R. M., Chulam, T., Pontremoli-Salcedo, M., Nozar, F., Fiol, V., … Schmeler, K. M. (2016). Project ECHO: A telementoring program for cervical cancer prevention and treatment in low-resource settings. Journal of Global Oncology, 3(5), 658–665. https://doi.org/10.1200/JGO.2016.005504

MacLean, T. L., Qiang, J. R., Henderson, L., Bowra, A., Howard, L., Pringle, V., Butsang, T., Rice, E., Di Ruggiero, E., & Mashford-Pringle, A. (2023). Indigenous cultural safety training for applied health, social work, and education professionals: A PRISMA scoping review. International Journal of Environmental Research and Public Health, 20(6), 5217. https://doi.org/10.3390/ijerph20065217

MacLeod, M. L., Kulig, J. C., & Stewart, N. J. (2019). Lessons from 20 years of research on nursing practice in rural and remote Canada. Canadian Nurse,115(3). www.canadian-nurse.com/blogs/cn-content/2019/05/13/lessons-from-20-years-of-research-on-nursing-pract

Mitra, D., Shaw, A., Tjepkema, M., & Peters, P. (2015). Social determinants of lung cancer incidence in Canada: A 13-year prospective study. Health Reports, 26(6), 12–20.

Nass, S. J., Cogle, C. R., Brink, J. A., Langlotz, C. P., Balogh, E. P., Muellner, A., Siegal, D., Schilsky, R. L., & Hricak, H. (2019). Improving cancer diagnosis and care: Patient access to oncologic imaging expertise. Journal of Clinical Oncology, 37(20), 1690–1694. https://doi.org/10.1200/JCO.18.01970

Nowell, A., & Campbell, C. (2020). Facing forward: The development of a cancer nursing knowledge and practice framework. Canadian Oncology Nursing Journal, 30(3), 208–211. https://doi.org/10.5737/23688076303208211

Ohri, N., Rapkin, B. D., Guha, C., Kalnicki, S., & Garg, M. (2016). Radiation therapy noncompliance and clinical outcomes in an urban academic cancer center. International Journal of Radiation Oncology, Biology, Physics, 95(2), 563–570. https://doi.org/10.1016/j.ijrobp.2016.01.043

Pfister, D. G., Rubin, D. M., Elkin, E. B., Neill, U. S., Duck, E., Radzyner, M., & Bach, P. B. (2015). Risk adjusting survival outcomes in hospitals that treat patients with cancer without information on cancer stage. JAMA Oncology, 1(9), 1303–1310. https://doi.org/10.1001/jamaoncol.2015.3151

Rural Health Information Hub. (2022, June 6). Social determinants of health for rural people. Rural Health Information Hub. www.ruralhealthinfo.org/topics/social-determinants-of-health

Schill, K., & Caxaj, S. (2019). Cultural safety strategies for rural Indigenous palliative care: a scoping review. BMC Palliative Care, 18(1), 21. https://doi.org/10.1186/s12904-019-0404-y

Shulman, L. N., Palis, B. E., McCabe, R., Mallin, K., Loomis, A., Winchester, D., & McKellar, D. (2018). Survival as a quality metric of cancer care: Use of the national cancer data base to assess hospital performance. Journal of Oncology Practice, 14(1), e59–e72. https://doi.org/10.1200/JOP.2016.020446

Statistics Canada. (2018, January 17). Geography. Statistics Canada. www150.statcan.gc.ca/n1/pub/11-402-x/2011000/chap/geo/geo-eng.htm

Statistics Canada. (2022, December 15). Population growth in Canada’s rural areas, 2016 to 2021. Statistics Canada. www12.statcan.gc.ca/census-recensement/2021/as-sa/98-200-x/2021002/98-200-x2021002-eng.cfm

Subedi, R., Greenberg, T. L., & Roshanafshar, S. (2019). Does geography matter in mortality? An analysis of potentially avoidable mortality by remoteness index in Canada. Health Reports, 30(5), 3–15. https://doi.org/10.25318/82-003-x201900500001-eng

Sundquist, S., Batist, G., Brodeur-Robb, K., Dyck, K., Eigl, B. J., Lee, D.K., Limoges, J., Longstaff, H., Pankovich, J., Sadura, A., Sullivan, P., & Dancey, J. E. (2021). CRAFT-A proposed framework for decentralized clinical trials participation in Canada. Current Oncology, 28(5), 3857–3865. https://doi.org/10.3390/curroncol28050329

Thompson, M. K., Poortmans, P., Chalmers, A. J., Faivre-Finn, C., Hall, E., Huddart, R. A., Lievens, Y., Sebag-Montefiore, D., & Coles, C. E. (2018). Practice-changing radiation therapy trials for the treatment of cancer: Where are we 150 years after the birth of Marie Curie? British Journal of Cancer, 119(4), 389–407. https://doi.org/10.1038/s41416-018-0201-z

Tremblay, D., Latreille, J., Bilodeau, K., Samson, A., Roy, L., L’Italien, M. F., & Mimeault, C. (2016). Improving the transition from oncology to primary care teams: A case for shared leadership. Journal of Oncology Practice, 12(11), 1012–1019. https://doi.org/10.1200/JOP.2016.013771

Ulrich, C. M., Ratcliffe, S. J., Zhou, Q., Huang, L., Hochheimer, C., Gordon, T., Knafl, K., Miller, V., Naylor, M. D., Schapira, M. M., Richmond, T. S., Grady, C., & Mao, J. J. (2022). Association of perceived benefit or burden of research participation with participants’ withdrawal from cancer clinical trials. JAMA Network Open, 5(11), e2244412. https://doi.org/10.1001/jamanetworkopen.2022.44412

Unger, J. M., Cook, E., Tai, E., & Bleyer, A. (2016). The role of clinical trial participation in cancer research: Barriers, evidence, and strategies. American Society of Clinical Oncology Educational Book. American Society of Clinical Oncology. Annual Meeting, 35, 185–198. https://doi.org/10.1200/EDBK_156686

Unger, J. M., Moseley, A., Symington, B., Chavez-MacGregor, M., Ramsey, S. D., & Hershman, D. L. (2018). Geographic distribution and survival outcomes for rural patients with cancer treated in clinical trials. JAMA Network Open, 1(4), e181235. https://doi.org/10.1001/jamanetworkopen.2018.1235

Walji, L. T., Murchie, P., Lip, G., Speirs, V., & Iversen, L. (2021). Exploring the influence of rural residence on uptake of organized cancer screening - A systematic review of international literature. Cancer Epidemiology, 74, 101995. https://doi.org/10.1016/j.canep.2021.101995

Wercholuk, A. N., Parikh, A. A., & Snyder, R. A. (2022). The road less traveled: Transportation barriers to cancer care delivery in the rural patient population. JCO Oncology Practice, 18(9), 652–662. https://doi.org/10.1200/OP.22.00122

Wilson, E. C., Pammett, R., McKenzie, F., & Bourque, H. (2021). Engagement of nurse practitioners in primary health care in northern British Columbia: A mixed-methods study. CMAJ Open, 9(1), E288–E294. https://doi.org/10.9778/cmajo.20200075

Wilson, C. R., Rourke, J., Oandasan, I. F., Bosco, C., On behalf of the Rural Road Map Implementation Committee, & Au nom du Comité sur la mise en œuvre du Plan d’action sur la médecine rurale (2020). Progress made on access to rural health care in Canada [Progrès réalisés dans l’accès aux soins de santé ruraux au Canada]. Canadian Family Physician, 66(1), 31–36.

World Population Review. (2023). Total population by country. World Populaiton Review. https://worldpopulationreview.com/countries

Yabroff, K. R., Han, X., Zhao, J., Nogueira, L., & Jemal, A. (2020). Rural cancer disparities in the United States: A multilevel framework to improve access to care and patient outcomes. JCO Oncology Practice, 16(7), 409–413. https://doi.org/10.1200/OP.20.00352

Zahnd, W. E., James, A. S., Jenkins, W. D., Izadi, S. R., Fogleman, A. J., Steward, D. E., Colditz, G. A., & Brard, L. (2018). Rural-urban differences in cancer incidence and trends in the United States. Cancer Epidemiology, Biomarkers & Prevention,27(11), 1265–1274. https://doi.org/10.1158/1055-9965.EPI-17-0430


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