A research team from the University Cancer Center studying obstacles to breast cancer care in Appalachia revealed nearly twice as many Appalachian women are diagnosed in the late stage of breast cancer as the U.S. national average.
The team also found around half of the women in Appalachia who had survived breast cancer and were eligible for adjuvant therapy, which is recommended to prevent relapse, did not receive this treatment.
The study was unique in the field for its use of a health informatics system, pulling cancer incidence and treatment data from state and federal resources to generate statistics which provide a quantitative metric for comparing the region to national standards.
One of the researchers, Public Health Science Prof. Rajesh Balkrishnan, cited a combination of factors contributing to health care disparities in Appalachia, which are deeply rooted in the physical isolation and history of the region.
“[O]ften times we find that patients have to drive over a hundred miles to get to tertiary cancer care centers,” Balkrishnan said.
Tertiary care centers provide cancer patients with the highly specialized medical personnel and equipment needed to most effectively treat their cancer.
Economic barriers also impede proper care. Balkrishnan connected the decline of historical industries, such as coal mining, to the disproportionate levels of poverty in the region.
“Our research essentially highlights a critical need to improve health care related to cancer treatment in this area of great socioeconomic, as well as geographic, deprivation to health care,” he said.
Another obstacle highlighted by the study comes from a lack of healthcare investment due to the low population density of the region and the high cost associated with administering care.
“[T]his is an area with [some of] the highest health care needs in the United States, but unfortunately the supply of healthcare is very low,” Balkrishnan said.
David Rouse, founding director of the Center for Appalachian Studies at U.Va. Wise, contrasted the disproportionate supply and demand of health care in much of Appalachia with the implementation of the Affordable Care Act in Kentucky.
“Kentucky has led the nation in terms of implementing the Affordable Care Act,” Rouse said. “[T]his has made the cost of getting regular health care much cheaper than it has been in other states.”
Access to routine health care increases the chances of detecting breast cancer at an earlier and more treatable stage.
“Virginia’s legislature refuses to implement any comparable program, and so consequently what one finds is Virginia, and what one used to find across the region, is you have a higher rate of advanced breast cancer because of the lack of regular health care,” Rouse said.
The lack of adherence to chemotherapy and adjuvant therapies following initial radiation or surgical treatments is not as evidenced numerically. Balkrishnan’s team conducted a qualitative study as well, interviewing survivors about their reasons for not following the recommended regimens of medication.
“[A] lot of them did mention things like side-effects [and] not knowing how to use their medications,” Balkrishnan said.
In addition to a general lack of education and awareness about their treatments, pain was also cited as a major obstacle to proper medication use.
“[W]hen women take these medications and experience pain, they kind of stop taking the medications,” he said.
Despite the complexity and varieties of these barriers to care, a number of solutions are in the works. Balkrishnan noted current and potential tools, including the University Telemedicine Center and medication reminder apps for smart devices.
“[O]bviously we need to recognize that access to essential health care should be the right of every American,” Balkrishnan said.
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