Disparities in Prostate Cancer Care: Addressing the Rural-Urban Health Divide
Rural communities in the United States experience poorer access and lower quality healthcare compared to urban communities. These circumstance may easily be found in the world. This disparity is also observed in prostate cancer care, including screening, diagnosis, and treatment.
Prostate Cancer Disparities in Rural Communities
Studies conducted in various countries including Australia, New Zealand, and the United States found that men living in rural areas are less likely to be screened with a prostate specific antigen (PSA) test and more likely to be diagnosed with high-risk cancer and metastatic disease. In New Zealand, the study by Obertova et. al. showed that men in the rural area are more likely not screened (43%) with PSA test (1). Furthermore, rural residents have lower rates of definitive treatment for localized urological cancer compared to their urban counterparts, even when controlling for clinical parameters, urologist density, and sociodemographic factors.
Variation in Diagnosis and Treatment between Rural and Urban Residents
The type of treatment also varies between rural and urban residents. As the distance to treatment centers increases, rural residents may opt for surgery over radiation, which requires multiple visits to healthcare facilities (2).
In addition, rural residents are more likely to receive surgical castration instead of medical castration for metastatic disease. These differences in diagnosis and treatment may lead to variation in survival, as several systematic reviews have concluded that prostate cancer patients had worse survival rates if they lived in rural areas.
Several health determinants contribute to this inequality in prostate cancer treatment between rural and urban populations, including behavioral, socioeconomic, environmental, and clinical factors. Physicians in rural areas identified lack of access to specialists and transportation as major barriers to receiving care. For example, the patients may travel over 2 hours for one way to see their health care providers which means that they need to spend a whole day for the treatment and diagnosis. This will lead them to lose wages and need extra help from family members or the additional health providers to drive them for 4 hours round trip for the visit (3, 4). Therefore, policy directed toward rectifying these barriers is necessary to improve care for rural patients.
Barriers to Prostate Cancer Care in Rural Areas
There is no doubt that the divide in rural and urban health is impacting the survival rates of the patients. Even if they are treated for their prostate related issues, they should spend extra time for the further prognosis. In order to lower the barriers for the patient, it is necessary to make more approchable medical conditions, such as, one-day diagnosis with accuracy, or one-stop health care service for the long distance patient.
In conclusion, the divide between rural and urban health is growing, and this disparity is observed in prostate cancer care. Rural patients experience reduced screening and delayed diagnosis, and they receive differential treatment or no treatment at all, which may lead to increased cancer mortality. Identifying the specific barriers that exist to physicians providing care and patients receiving care is the first step in rectifying this disparity for providing the better medical environment.
Obertová Z, Hodgson F, Scott-Jones J et al: Rural-urban differences in prostate-specific antigen (PSA) screening and its outcomes in New Zealand. J Rural Health 2016; 32: 56.
Holmes JA, Carpenter WR, Wu Y et al: Impact of distance to a urologist on early diagnosis of prostate cancer among Black and White patients. J Urol 2012; 187: 883.
Magnaty A et al: Differences in Prostate Cancer Treatment in Rural vs Urban Settings. American Urological Association 2021;
Baldwin LM, Andrilla CHA, Porter MP et al: Treatment of early-stage prostate cancer among rural and urban patients. Cancer 2013; 119: 3067.
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