Public Health Strategies to Help People with Cancer in Rural Communities

A Practice Guide for Health Practitioners

Program Site; Expert Hub Team; Health Care Provider Team; Patient Navigators; and Cancer Survivors
Project ECHO and Patient Navigation Model

Each site worked to engage both Project ECHO (depicted as the expert hub team working with health care provider teams in rural communities) and patient navigators to improve the health and wellness of people with cancer in rural communities.

People living in rural areas of the United States face higher cancer mortality than people living in urban areas, despite lower overall cancer incidence.1 People in rural areas typically have limited access to cancer care specialists and rely on primary care providers for ongoing care.

Telementoring through Project ECHO (Extension for Community Healthcare Outcomes) and patient navigation are two promising approaches to improve health care for people with in rural areas.2–5 Project ECHO uses telementoring within communities of practice to increase workforce capacity and enhance rural health care providers’ knowledge and skills. At the same time, patient navigation aims to remove barriers to care across the cancer care continuum and connect people with the community resources they need.

CDC’s Pilot Program

The Centers for Disease Control and Prevention’s (CDC’s) Division of Cancer Prevention and Control selected four National Comprehensive Cancer Control Program (NCCCP) award recipients (pilot sites) to conduct a pilot project, Improving the Health and Wellness of Cancer Survivors in Rural Communities.

The pilot project’s goal was to bridge the health equity gap experienced by people with cancer in rural communities. For 12 months, each pilot site implemented telementoring and patient navigation strategies aligned with the needs and resources of its rural population. The pilot project provided valuable insight into the successful implementation of these strategies. This practice guide highlights four keys to success that health practitioners can use.

Pilot Sites

  • Kansas Department of Health and Environment
  • Montana Department of Public Health and Human Services
  • Nevada Cancer Coalition
  • South Carolina Department of Health and Environmental Control
Keys to Success for Improving Care for People with Cancer in Rural Areas

Collaborate with partners that have similar goals.

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Tailor program services to local needs and resources.

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Recruit and educate health care providers and patients.

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Monitor and evaluate program implementation.

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1Henley SJ, Anderson RN, Thomas CC, Massetti GM, Peaker B, Richardson LC. Invasive cancer incidence, 2004–2013, and deaths, 2006–2015, in nonmetropolitan and metropolitan counties—United States. MMWR Surveillance Summaries 2017;66(14):1–13.

2Freeman HP, Rodriguez RL. History and principles of patient navigation. Cancer 2011;117(15 Suppl.):3539–3542.

3Alverson DC. An introduction to project ECHO. Rural Health Quarterly 2017.

4Bhavaraju N, Nanni JE, Carlson C, Sholk J, Peterson K, Smith LA. Breaking the barriers to specialty care: Practical ideas to improve health equity and reduce cost. 2016.

5O’Neil ME, Henley SJ, Rohan EA, Ellington TD, Gallaway MS. Lung cancer incidence in nonmetropolitan and metropolitan counties—United States, 2007–2016. MMWR 2019;68:993–998.