We need to shift away from viewing rural health care through a deficit lens -- rural communities have strengths.
If you live in rural or remote Australia and are diagnosed with cancer, you’re less likely to survive than someone in the city with the same disease. Our research shows people in rural Australia are 13% less likely to survive their cancer, in the first five years after diagnosis.
For the seven million Australians living outside major cities, this inequity is reflected in every stage of cancer care, from prevention through to end-of-life support.
Our five-paper series published today in The Lancet Regional Health – Western Pacific explains why – and how to address these disparities.
Why the difference?
We analysed survival data from 37 studies across multiple countries involving people diagnosed with cancer and found a consistent pattern: the more remote your location, the worse your chances.
This happens for several interconnected reasons. But access to health service in the early stages is instrumental in influencing survival. People in rural areas often find it harder to get screened for cancer, meaning tumours are caught later when they’re more difficult to treat.
When symptoms do appear (such as pain, changes in bowel habits, fatigue or unintentional weight loss) distance to doctors and long wait times can delay diagnosis.
Treatment usually means travelling
Once diagnosed, many Australians in rural areas face a difficult choice: relocate to the city for treatment, make exhausting and expensive regular trips for appointments, or decline the recommended treatment if it requires travel or relocation.
Radiation therapy, a cornerstone of cancer treatment, is mostly only available in metropolitan areas, as is specialised cancer surgery. This means people in rural areas must travel long distances for treatment, often requiring weeks or months away from home, family and work.
Consider what this means in practice. A farmer (who is likely also the family bread-winner), during harvest season, needs weeks of daily radiation therapy 300 kilometres away.
A parent with school-age children recommended three sequential types of treatments across three different locations, and not enough leave to cover the months this will take.
A retired widower is anxious to be in a city alone and wants to stay with their local support system.
Taking weeks or months away from home isn’t just inconvenient – it can mean financial hardship, disrupted family life and isolation from support networks.
Some people choose to decline treatment, knowing the outcome is a shorter life expectancy, rather than face these barriers. Others push through, but the financial and emotional costs are significant.
Not just about distance
Rural hospitals often lack specialist cancer services. While they might be able to deliver chemotherapy, they might not have oncologists on site. Specialised cancer surgeons and radiation therapy facilities can be even rarer.
Clinical trials can offer cutting-edge treatments, deliver better outcomes and are considered a marker of quality cancer care. But access is limited in the country.
Availability of allied health support (physiotherapy, dietetics and occupational therapy) and psychosocial supports (psychology and social work) is limited.
Rural hospitals face workforce shortages and fewer specialists. Unlike metropolitan hospitals, multidisciplinary teams are less likely to meet regularly to discuss the best way to treat complex cases. Specialists have fewer opportunities to build experience with specific cancer types due to lower patient numbers.
These factors all affect the range and consistency of treatment options available.
Training staff won’t solve system failures
Rural communities are diverse. A farming town in Victoria faces different challenges than a regional centre in Queensland. Solutions need to be developed with these communities, not imposed on them.
Yet our analysis of health-care interventions in rural areas found most rely heavily on training and educating staff, with little attention to fixing the underlying system problems. Few studies reported meaningful engagement with rural communities or health-care professionals in designing solutions.
This approach places the burden on individuals – expecting patients to travel long distances or doctors to fill workforce gaps – rather than addressing policy, funding and infrastructure issues.
Building on rural strengths
Our examination of the historical evolution of cancer policy in Australia found Australia’s Cancer Plan (2023-2033) is one of the world’s strongest in addressing rural cancer inequities. The plan aims to ensure all Australians receive optimal cancer care, regardless of where they live. But policy is only the first step.
We need place-based solutions developed in genuine partnership with rural communities. This means involving rural health-care workers, patients and community members from the beginning – not just asking them to implement programs designed in cities.
This could include:
- expanding telehealth for specialist consultations, so rural patients can access expert advice without travelling
- better travel and accommodation support for patients who travel for treatment
- patient navigation programs to help coordinate complex care across distances.
Rural health services are often agile and well-positioned for research and innovation. They’re usually the primary health organisation in their community, making changes more straightforward than in complex metropolitan networks.
However, we need better data to understand if these solutions work. Currently, rural cancer patients are often underrepresented in research databases. When data from across the country are combined, rural outcomes can disappear into the larger numbers from cities. Better data collection – including tracking where patients live and their remoteness – will help us see whether interventions are making a difference.
Finally, we need to shift away from viewing rural health care through a deficit lens. Rural communities have strengths: strong social connections, established relationships with local health-care providers and dedicated community members with deep knowledge of their local challenges. These should be leveraged.
Achieving cancer equity for Australians in rural areas requires coordinated action and sustained investment in rural infrastructure and capacity. Cancer survival shouldn’t depend on where you live.
Charlene Wright, Research Fellow, Equitable Cancer Outcomes across Rural and Remote Australia (ECORRA), Deakin University; Anna Ugalde, Associate Professor & Victorian Cancer Agency Fellow, Deakin University; Laura Alston, Senior Research Fellow, Deakin University, and Skye Marshall, Associate Professor of Rural Health Research, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.