BACKGROUND
Medical care in the United States and Canada is not equal for all people. The ability of a person to see, or their willingness to see, a health care provider depends on a wide range of factors, including a person’s social, economic, cultural and religious background. Many studies also demonstrate that a person’s access to, and/or willingness to pursue, medical care depends on where they live. People who live in rural areas of the United States and Canada, for example, generally receive less health care, including both general and specialized care, than people living in urban (city) settings. This means that for people living in rural areas, disease is identified and treated later than it is for people living in urban settings. For these reasons, people living in rural areas tend to be diagnosed at more advanced stages of disease, making them more ill and less likely to survive disease, compared to people living in cities with the same diagnosis. This is true for many kinds of disease, including thyroid cancer, which requires surgery for treatment.

The authors of the study presented here seek to understand the challenges for surgeons who work in rural settings in providing thyroid cancer care to people living in rural areas of the United States and Canada. In so doing, they hope to better understand why such people are less likely to receive care for thyroid cancer, and why, when care is received, this happens later in the course of disease compared to people living in cities.

THE FULL ARTICLE TITLE
Huston-Paterson HH et al. Closing the distance: a qualitative study to identify equitable innovations for rural thyroid cancer treatment. Am Surg. Epub 2024 Dec

SUMMARY OF THE STUDY
The study authors interviewed 13 surgeons (6 women and 7 men) trained in general surgery, all of whom work in rural areas across the United States or Canada. This was done by telephone call, video conference and/or in person visit. The interviews focused on all aspects of thyroid cancer care, including initial diagnosis, treatment and survivorship after treatment. For each aspect of thyroid cancer care, interviews included questions focusing on the availability of resources for care, the presence of deficiencies that might impact care and how care might be improved.

When the authors analyzed the results of their surgeon interviews, they identified four areas that might negatively impact the ability of people living in rural areas to receive thyroid cancer care:

1. The interest and ability (expertise) of the local surgeon to treat thyroid cancer

2. Feelings of isolation on the part of local surgeons (absence of other health care providers like them) when providing thyroid cancer care

3. The absence of key local non-surgeon specialists also needed for thyroid cancer care (specifically endocrinologists)

4. The preference of people living in rural areas to avoid traveling away from home to pursue thyroid cancer treatment

The interviewed surgeons expressed need for more communication and collaboration among health care providers caring for people diagnosed with thyroid cancer, including increased support from major health care institutions in their regions. The authors also learned that thyroid cancer care in rural areas was negatively impacted by the need for family support at home, the need to meet family responsibilities, the negative impact of travel for medical care on job responsibilities/employment and the increased cost associated with traveling away from home for health care.

In light of their findings, the authors of this study suggest that thyroid cancer care for people living in rural areas could be improved in several ways. These include increasing the availability of, and access to, endocrinologists (specialists with particular expertise in thyroid disease) in rural areas, providing education related to thyroid cancer care to rural health care providers treating thyroid cancer, and developing expanded methods for communication and partnership among health care providers treating thyroid cancer in rural settings.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This work adds to our understanding of why people living in rural areas are less likely to pursue and/or receive thyroid cancer care (and, by extension, health care in general) than are people living in city settings. The interviewed surgeons revealed clear reasons why thyroid cancer care is more difficult in rural areas than in cities, including decreased availability of colleagues to assist with care (including endocrinologists) and decreased ability to communicate with, and receive assistance from, regional health care centers having more treatment resources. This study does focus on a small number of general surgeons, who may not play a comprehensive role in thyroid cancer treatment in general, rather than including other important types of care providers, including nurse practitioners, physician’s assistants, community health workers, head and neck surgeons and social workers. This study also involved relatively few geographic locations, making its findings somewhat limited relative to how much they represent the general state of thyroid cancer care in rural America and in rural Canada. Nonetheless, this study provides the groundwork for more comprehensive research exploring the challenges of treating thyroid cancer in rural settings.

— Jason D. Prescott, MD PhD

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