Investigators Identify Requirements to Potentially Optimize Cancer Survivorship Care for Patients in Rural Areas

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The vast majority of cancer survivors may rely on primary care physicians for follow-up treatments, especially in rural areas, according to a new study published by Becevic et al in the Journal of Cancer Education.


Patients often depend on their primary care physicians to help them navigate the steps in their cancer care, seeking their advice regarding necessary tests or to explain the oncologist’s recommendations. As technology advances, the number of cancer survivors is expected to continue to rise. Nonetheless, cancer survivors are not all guaranteed access to follow-up care. Currently, there are about 6 oncologists for every 100,000 U.S. adults, with only 10% of oncologists living in rural areas, a significant hurdle to the health of rural cancer survivors.

“Cancer survivors from rural areas reported worse symptoms caused by treatment, but [as a result of] travel distance and costs, they may return to their primary care [physicians] and stop seeing oncologists sooner than patients from urban areas,” noted lead study author Mirna Becevic, PhD, Assistant Professor of Dermatology at the University of Missouri School of Medicine. “Patients in rural areas report feeling stressed as they face significant barriers to receive cancer survivorship care.”

Study Methods and Results

In the new study, investigators discovered that roughly 96% of cancer survivors reported visiting with their primary care physicians for follow-up treatment and survivorship care, with 60% of the patients seeing an oncologist. The disparity was found to be greater in rural areas, where specialized health care may require hours of travel to access and may be more expensive than visiting the neighborhood physician.

The investigators then conducted interviews with 17 nononcology physicians—67% of whom practiced medicine in rural areas—and asked them about their current approaches to cancer survivorship care as well as what they need to improve that care. The majority of the physicians who participated in the interviews relied on training from their residency years, if they received any; on the patient’s own oncology notes; and on their personal accounts of treatment. However, they consistently noted that the few resources available in rural areas made treatment and outreach more difficult.


“[Physicians] expressed a desire to have more access to information and online and offline trainings—like curbside consults, accessible and updated guidelines, and webinars,” emphasized Dr. Becevic. “More educational opportunities would be beneficial, especially to identify conditions specifically caused by cancer, or at least flag something for closer attention,” she added.

The investigators concluded that these barriers to cancer survivorship care can be overcome by using technology and telehealth to expand the reach of primary care physicians or equipping them with the tools they need.

Disclosure: For full disclosures of the study authors, visit

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®.