Consequences of Structural Urbanism: Urban–Rural Differences in Cancer Patients’ Use and Perceived Importance of Supportive Care Services from a 2017–2018 Midwestern Survey

Abstract

Background: Structural inequities, in part, undergird urban–rural differences in cancer care. The current study aims to understand the potential consequences of structural inequities on rural and urban cancer patients’ access to and perceived importance of supportive cancer care resources. Methods: We used data collected from November 2017 to May 2018 from a larger cross-sectional needs assessment about patients’ support needs, use of services, and perceptions at a Midwestern United States cancer center. Oncology patients received a study packet during their outpatient clinic visit, and interested patients consented and completed the questionnaires. Results: Among the sample of 326 patients, 27% of the sample was rural. In adjusted logistic regression models, rural patients were less likely to report using any secondary support services (15% vs. 27%; OR = 0.43, 95%CI [0.22, 0.85], p = 0.02) and less likely than urban counterparts to perceive secondary support services as very important (51% vs. 64%; OR = 0.57, 95%CI [0.33, 0.94], p = 0.03). Conclusion: Structural inequities likely have implications on the reduced access to and importance of supportive care services observed for rural cancer patients. To eliminate persistent urban–rural disparities in cancer care, rural residents must have programs and policies that address cancer care and structural inequities.