Studies show that rural populations experience greater cancer disparities across the cancer control continuum—from prevention and incidence to survivorship and mortality—compared with their urban counterparts. Those living in rural parts of the United States also tend to have lower cancer screening rates compared with individuals living in urban centers. The barriers to cancer care in rural settings are many, including an oncology workforce shortage, longer travel times to access care, and higher out-of-pocket medical costs.

Results from a randomized controlled study by Paskett et al investigating the impact of area deprivation on cancer screening and intervention effectiveness showed that remote interventions—particularly, a mailed tailored DVD plus patient navigation provided via telephone—increased adherence to breast, cervical, and colorectal cancer screenings among women living in rural counties in the United States. The findings demonstrate the need to focus on geographic areas with higher economic deprivation to increase cancer screening adherence. The study was presented during the Union for International Cancer Control World Cancer Congress 2022 during the Women’s Cancer Prevention, Screening, Early Diagnosis session on October 18.

Study Methodology

In this study, 983 women aged 50 to 74 years were randomly assigned receive one of the following interventions: a mailed tailored DVD intervention, a DVD intervention plus telephonic patient navigation, or usual care. The goal was to evaluate the efficacy of each intervention to simultaneously increase adherence to any breast, cervical, and colorectal cancer screening that was not up to date at baseline. The participants lived in 99 rural counties in Ohio and Indiana.

The interventions focused on constructs associated with cancer screening, including knowledge, perceived personal risk for cancer, and benefits and self-efficacy, as well as resolving barriers to obtaining the needed tests. Of the 983 women enrolled in the trial, 19% needed all three screening tests, 29% needed two tests, and 52% needed one test. The majority of the participants were married, insured, and White, and 84% reported educational attainment past high school.

The national percentile of adjusted area-level deprivation index was 66 (range = 1–100), with higher scores indicating higher economic deprivation.

Results

The researchers found that at 12 months, the percentage of women receiving all needed screenings was 10% for those receiving the usual care intervention, 15% for those receiving the mailed DVD intervention, and 30% for women receiving the combined DVD/telephonic patient navigation intervention (odds ratio [OR] = 1.9 and 5.8, respectively vs usual care, P < .001). A total of 25% of participants in the usual care arm, 29% in the DVD arm, and 49% in the DVD/phone navigation arm received any needed screenings (OR = 3.8 for DVD/phone navigation vs usual care, P < .001).

The adjusted area-level deprivation index was significantly related to receiving both, all, or any needed screenings at 12 months, with those in higher deprivation areas having lower adherence (P = .004 and P = .031, respectively) in adjusted models. No interaction of area-level deprivation index with the interventions was found.

“This is the first study to compare interventions to simultaneously increase adherence to three screening tests in rural women, a medically underserved population with higher cancer mortality. Results demonstrate the value of these remote interventions, especially phone navigation, in rural areas, and point to the need to focus on areas with higher economic deprivation to increase cancer screening adherence,” concluded the study authors.

Disclosure: This study was supported by a grant from the National Institutes of Health and the National Cancer Institute.