Background:
Approximately 32 million Americans living in rural counties lack access to multidisciplinary cancer care, facing disproportionately unfavorable social determinants of health (SDoH), financial toxicity, and symptom burden. The inequities are mirrored globally—particularly in low- and middle-income countries (LMICs)—where palliative care (PC) remains inaccessible to the majority of those in need. This article explores pragmatic and scalable models to improve palliative and supportive oncology care delivery in rural and resource-limited settings.
Design and Participants:
This is a narrative and policy-focused educational review published by the ASCO Educational Book, synthesizing current literature, workforce assessments, and implementation examples from both U.S. and LMIC contexts. The authors examine systemic barriers in access to PC, the influence of SDoH on cancer outcomes, and present a multi-level framework of interventions including technology-enabled care, community engagement, and workforce adaptation.
Key strategies reviewed include:
Results:
The review highlights striking disparities: 66% of rural U.S. counties lack oncologists; over 90% of PC physicians and NPs are concentrated in metropolitan areas; and global data show that only 14% of those needing PC receive it—less than 3% in children. Barriers include workforce shortages, regulatory opioid constraints, geographic isolation, limited infrastructure, and cultural misconceptions about PC.
Programs like ThedaCare’s regional cancer network and Kerala’s Neighborhood Network in Palliative Care demonstrate scalable success through EMR integration, telehealth, local navigation, and CHW-based models. Globally, LMIC-specific frameworks grounded in WHO’s six-element PC development model emphasize community participation, sustainable funding, and context-sensitive service design.
Commentary:
This comprehensive review bridges oncology, palliative medicine, and health equity by addressing the structural and social determinants driving disparities in rural and underserved settings. It underscores that effective palliative care delivery must be both contextual and adaptive, leveraging telehealth, local partnerships, and culturally aligned community engagement. The “hub-and-spoke” model stands out as a realistic paradigm for extending quality symptom management and end-of-life care beyond tertiary centers. Equally compelling is the call for integration of SDoH assessment into routine oncology workflows, ensuring that social and logistical barriers are treated as core clinical priorities. For LMICs, the paper advocates for task-shifting, sustainable financing, essential opioid access, and public education—highlighting that palliative care, as a human right, should not be geographically or economically constrained.
Bottom Line:
Palliative care access gaps in rural and underserved populations remain a critical global equity issue. Multi-level interventions—combining hub-and-spoke models, telehealth, CHW engagement, and SDoH-informed care planning—offer viable solutions. Integration of palliative care into primary and oncology systems, supported by policy reform and community collaboration, is essential to achieving universal, compassionate care delivery.
Reference:
Weiss M, Sabo-Wagner S, Frydman J, Pramesh CS. Addressing Barriers in Palliative Care for Rural and Underserved Communities. ASCO Educational Book. 2025;45(3). doi:10.1200/EDBK-25-472842Links to an external site.
weiss-et-al-2025-addressing-barriers-in-palliative-care-for-rural-and-underserved-communities.pdf
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