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PCP Insights Needed to Improve Cancer Screening in Rural Appalachia

By Richard Ingram, MD


June 15, 2022
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If you have ever struggled with making a difference in cancer care, now is the time to take heart. Since the passage of the 1971 National Cancer Act, there has been no movement to align and support all stakeholders who are interested in advancing cancer care in America. The Biden Administration recently reignited the Cancer Moonshot initiative to accelerate progress against cancer via a 1.8 billion dollar investment. Cancer Moonshot has three specific goals: to advance scientific discovery, foster collaboration, and improve data sharing.

As the Association of Community Cancer Center’s (ACCC’s) Appalachian Community Cancer Alliance Steering Committee Chair, I invite you to join us as we harness the momentum of this auspicious time.  I am especially interested in reaching primary care providers (PCPs)—the bedrock of all patient care.

As a medical oncologist in rural Virginia and President of the Virginia Association of Hematologists and Oncologists, I was motivated by my own frustrations over disparities in care to help build this alliance. By joining other like-minded oncology professionals, we discovered shared concerns over care fragmentation in the Appalachian Region, where poverty and lack of healthcare resources are common denominators.

The alliance grew from our collective belief that if one of us could innovate a solution, then all of us could benefit by applying it. Through combined efforts, the alliance seeks to reduce care fragmentation and address barriers that drive poor patient outcomes. It was created to develop interdisciplinary, patient-centered approaches to cancer care, beginning with prevention and through survivorship, with an emphasis on enhanced quality-of-life. We intend to accomplish this by developing an effective, integrated approach to problem solving to include in the healthcare system on behalf of all our patients.

Our Approach Is Working

In rural Appalachia, where the cancer incidence rate is 32 percent higher than the national rate, the Alliance’s advocacy has informed the creation of a lung cancer screening project that has been recognized by President and First Lady Biden. The Rural Appalachian Lung Cancer Screening Initiative’s goals are to identify and address disparities in lung cancer screening for this region. The initiative will leverage ACCC’s existing portfolio of tools and best practices for reducing cancer deaths in underserved populations, and its advisory task force will be comprised of interdisciplinary stakeholder members from the Appalachian Region.

But for the alliance to truly succeed, we must turn to the PCPs in these communities. You are the “boots on the ground.” The providers who know best the kinds of healthcare dilemmas Appalachian patients face. You are the ones who have, more times than you wish to recall, witnessed patients choosing between their care and paying for other living costs, such as fuel to reach the nearest imaging center (that may be 50 miles away) or paying their electricity bill.

Because you know the common barriers to preventive care in your community, you will have the best ideas about how to effectively surmount them. By becoming involved in the alliance, you can make your ideas heard and find the support that is needed to turn these ideas into sustainable solutions. You also will help forge a meaningful network across the Appalachian Region’s cancer professionals and PCPs for collaboration.

And because you do not have to live in the Appalachian Region to find disparities in cancer care, the Appalachian Community Cancer Alliance will extend its knowledge to others when its members discover effective care models for the region to help improve cancer care for all underserved communities.

The potential is great, but we run the risk of frustration if we do not include all stakeholders and listen to all points of view in our efforts to change how cancer care is delivered. For our efforts in the alliance to succeed, we need PCPs’ insights.

To inquire about becoming a member of our steering committee or to get involved, contact Ashley Lile, ACCC program manager. You can also sign up to receive regular updates on our activities, resources, and other events.

I look forward to hearing and collaborating with PCPs on their views for what we can do to better serve our oncology patients and communities.

Richard Ingram, MD, is a medical oncologist at Shenandoah Oncology in Winchester, Va., and president of the Virginia Association of Hematologists and Oncologists.



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