Study: Rural cancer patients cross state lines for specialized care

In a federally funded study, researchers from Huntsman Cancer Institute at the University of Utah (the U) found that 7% of Medicare patients cross state borders for cancer care, and rates were nearly double for those who lived in rural areas. This has important implications for telehealth policies and physician licensure, says Tracy Onega, PhD, MA, MPAS, MS, senior author of the study, senior director of population sciences at Huntsman Cancer Institute, and professor of population sciences at the U. A key research priority at Huntsman Cancer Institute is working to enhance access to care for cancer patients who live far from a major medical center.

Cancer patients, especially in rural areas, often travel far distances to receive specialized cancer care. But there are limitations on how physicians can follow up with their patients and practice across state lines, virtually, with telehealth. We can use the data from this study to inform policy and practices in order to remove this kind barrier to health care."

Tracy Onega, PhD, MA, MPAS, MS, senior author of the study, senior director of population sciences at Huntsman Cancer Institute, and professor of population sciences at the U

The team-whose research results were published in JAMA Network Open-surveyed over 1 million Medicare beneficiaries with cancer. For patients enrolled in the federal health insurance program, designed to cover health care for Americans over 65, they found that 8.3% of all cancer patients crossed state lines for surgical procedures, 6.7% for radiation therapy, and 5.6% for chemotherapy.

Those figures were much higher for rural patients. Among this population, 18.5% traveled to other states for surgery, 16.9% for radiation therapy, and 16.3% for chemotherapy.

Onega says telemedicine, the delivery of health-related care through virtual conversations with a health care professional, can't replace these types of services provided in a clinical setting. Instead, she says telemedicine can fill in gaps in cancer treatment.

"Patients are traveling across state lines for specialized cancer treatment services that need to be done in a brick-and-mortar clinic-but surgical assessment and follow-ups could be offered by telehealth. A surgeon can follow patients remotely, and they can assess their progress from a distance," says Onega. "This would reduce additional travel burdens for all patients and their caregivers, especially those in rural and frontier areas."

Telehealth in cancer care can also be used to manage treatment-related side effects, clinical trial check-ins, and prevention services.

Onega says access to this service is particularly important for Huntsman Cancer Institute, whose clinicians provide comprehensive cancer care to five largely rural Mountain West states: Idaho, Montana, Nevada, Utah, and Wyoming. Many patients travel far distances to access health care, in particular the kind of specialized care that's needed for cancer treatment.

The use of telemedicine in health care has boomed since the COVID-19 pandemic. According to the National Center for Health Statistics, 37% of adults over the age of 18 were found to have used telehealth in 2022.

But stumbling blocks remain. The practice of medicine is governed by individual state medical boards and the cross-state licensure policies vary by state. Some states have more favorable telehealth policies, encouraging connected care regardless of location, while others have retained decades-old policies predating telehealth technologies. Unfortunately, for many rural patients, antiquated medical licensure governance prohibits their providers from engaging with them through telehealth.

"Some states have reciprocity, meaning that a doctor licensed in Utah may also be automatically licensed in the next state over. But that is limited," says Onega. "It would be great to expand those options so that we don't have so many of these barriers for physicians to be able to provide services across state lines by telehealth."

Onega says an altered policy could mean better outcomes for patients, their caregivers, provider teams, and insurers.

"The patients are always first. We have so many improvements in cancer care technologies now, many of which are benefiting patient outcomes. People are living longer and better lives after a cancer diagnosis," says Onega. "We want to make sure that people who live far away from an urban area can have all the same benefits."

The research described in this release is supported by the National Institutes of Health/National Cancer Institute including P30 CA042014, and Huntsman Cancer Foundation.