Dr Lawrence N. Shulman Reveals Similarities in Cancer Care Challenges Between the Rural US and Rwanda

There are similarities between the challenges of accessing good cancer care in rural areas of the United States and Rwanda, such as poverty, transportation, and lack of routine care, said Lawrence N. Shulman, MD, director of the Center for Global Cancer Medicine at the Abramson Cancer Center, and professor of Medicine at the Hospital of the University of Pennsylvania.

You have done work in Rwanda on improving access to care. How can improvements be made in rural areas in the US to improve access to care and prevent delayed diagnoses?
A lot of the problems that we deal with trying to provide good cancer care in Rwanda are true in rural areas of the United States, particularly in the middle of the country and in the southern regions, in Appalachia and areas similar to that. The results are a function of the same things. They’re a function of poverty, patients not having healthcare at the top of their priority list. They’re more worried about putting food on the table for the next day and they don’t go for routine care, and they don’t go for cancer screening, and therefore, they come in late in the course of their disease just as our patients in Rwanda frequently do.

In addition, unfortunately, even with health insurance, out-of-pocket costs and other costs of going through cancer treatment is a huge burden for all patients in the US, but particularly for patients who are living on limited budgets. Transportation, trying to get to centers to stay on time with their treatments and so on are all more challenging for patients in Appalachia as it is for our patients in Rwanda. It’s very clear from lots of data both from the US and other places in the world that these barriers result in inferior cure rates, more patients are dying of cancer than really should be.
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