Public Health Strategies for Rural Cancer Policy Brief

CDC's Tips From Former Smokers educational campaign features stories of people who formerly smoked living with smoking-related health conditions. Since 2012, CDC estimates that at least a half million people who smoke cigarettes have quit for good because of the campaign.14 Spiritual leaders and places of worship have played an important role in addressing social challenges and protecting people who are at risk.1015 The campaign provides a range of resources for faith-based communities and leaders.16

Human papillomavirus (HPV) vaccination protects against cancers caused by HPV infection,17 but vaccination rates for children are lower in rural areas.3 One significant barrier to HPV vaccination in rural areas is cost,18 especially since rural residents are less likely to be insured. 3Policies like the Federal Vaccines for Children Program have expanded access to many vaccines at a reduced out-of-pocket cost. Reducing out-of-pocket costs by paying for vaccinations, providing insurance coverage, or reducing copayments increases vaccination rates in rural areas.19

Colorectal cancer is the second leading cancer killer in U.S. adults.20But colonoscopies may be difficult for rural patients to schedule because they require a day of preparation, access to a colonoscopist, and someone to drive the sedated patient home.2122 One option to consider is a stool test when discussing screening options. It can be done in a patient's home via a mail-in kit.23 If the test indicates potential cancer, a follow-up colonoscopy can then be scheduled. The use of stool test kits has been shown to raise screening rates.24

Even after receiving a cancer diagnosis, rural residents are less likely to seek early-stage treatment and necessary follow-up care, resulting in a higher likelihood of death.10 Provider shortages in rural areas and lack of transportation play a key role in rural resident cancer deaths. State Rural Transit Assistance Programs (RTAPs)25 provide community leaders with workshops, on-site training, educational materials, and peer assistance to help them develop public non-emergency medical transit programs.

The Southern Coalfields Tobacco Prevention Network in West Virginia provides tobacco-use policy guidance and prevention programs to a network of schools in six county coalitions. The guidance focuses on the unique needs of West Virginia populations who use tobacco the most, such as coal miners. For example, the network's Spit It Out program offered tobacco cessation services for hundreds of smokeless tobacco users and resulted in five workplaces going tobacco-free.

Accountable Care Organizations (ACOs) are networks of health care providers who share responsibility for providing patient care. ACOs create financial incentives to cooperate, share information, and save money, while providing coordinated, high-quality care to their Medicare patients.29 In Nebraska, a rural primary care ACO leveraged the incentives to promote colorectal cancer screenings. They used electronic health records and team-based care providers to identify patients eligible for and in need of screening. They then made sure the patients completed the procedures. This helped them to more effectively promote colorectal cancer screenings at lower costs.

In rural Idaho, a clinic raised its colorectal cancer screening rates from 52% to 69% by:

• Gathering baseline data.
• Sending electronic and mail reminders to patients.
• Using appointments and public health events to promote screenings.
• Utilizing stool tests, if indicated, for patients without insurance coverage.
• Encouraging competition between clinic providers on their screening rates.

Hispanic women have higher rates of cervical cancer than any other ethnic group in America, yet often lack Spanish-speaking health care providers. In rural Georgia, the Salud es Vida (Health is Life) program targeted female Hispanic farmworkers. The program educated lay health workers (promotoras) about cervical cancer and the HPV vaccine that can prevent it. After receiving the information, the promotoras became more willing to be screened. They filled a critical gap by promoting screening and vaccines to others in their communities.