Cancer patients living in large rural towns travel an average of 51 minutes to get to any oncology care, and those in small or isolated towns travel 59 minutes.⁠

Onega T, Duell EJ, Shi X, et al. Geographic access to cancer care in the U.S. Cancer. 2008;112:909-18.

With the decline in manufacturing jobs, many rural economies are based heavily on self-employment and small businesses. Rural residents have lower rates of employer-sponsored health coverage with less access to the Family and Medical Leave Act.

Goetz SJ. Self-employment in rural America: The new economic reality. Rural Realities. 2008;2:1-13.

Only 3% of medical oncologists practice in rural areas, whereas 20% of the US population resides in rural areas according to an American Society of Clinical Oncology’s workforce analysis.

Kirkwood MK, Bruinooge SS, Goldstein MA, et al. Enhancing the American Society of Clinical Oncology workforce information system with geographic distribution of oncologists and comparison of data sources for the number of practicing oncologists. J Oncol Pract. 2014;10:32-8.

Many small rural cancer centers do not have sufficient volume to support dedicated clinical trial research nurses, often leading to poor trial accrual.⁠

Charlton M, Schlichting J, Chioreso C, Ward M, Vikas P. Challenges of Rural Cancer Care in the United States. Oncology (Williston Park). 2015;29(9):633-640.

Fatalistic beliefs about cancer prevention can be a significant deterrent to one's likelihood of engaging in cancer prevention behaviors. Rural residents are more likely to endorse multiple fatalistic beliefs about cancer prevention than urban residents. Those expressing fatalistic beliefs were 2.3 times more likely (95% CI = 1.24-4.27, P = .008) than the remainder to indicate never having an endoscopy.

Befort CA, Nazir N, Engelman K, Choi W. Fatalistic cancer beliefs and information sources among rural and urban adults in the USA. J Cancer Educ. 2013;28(3):521-526. doi:10.1007/s13187-013-0496-7⁠

Crosby RA, Collins T. Correlates of Community-Based Colorectal Cancer Screening in a Rural Population: The Role of Fatalism. J Rural Health. 2017;33(4):402-405. doi:10.1111/jrh.12257⁠

Recruiting and retaining cancer specialists in small rural practices may result in a feeling of professional isolation. ⁠Kutoane and colleagues reviewed the literature for interventions to combat rural professional isolation and concluded there was insufficient research on the subject.

⁠Kutoane M, Brysiewicz P, Scott T. Interventions for managing professional isolation among health professionals in low resource environments: A scoping review. Health Sci Rep. 2021;4(3):e361. Published 2021 Sep 12. doi:10.1002/hsr2.361