No oncology patient left behind: Challenges and solutions in rural radiation oncology

Health inequities and decreasing median American lifespan, potentiated by the worldwide COVID 19 crisis, have taken centre stage in the public consciousness. Specifically, for this discourse, rural radiation oncology challenges external to the pandemic and unique to the rural American radiation oncology care delivery result from a confluence of the following: a) increased incidence of cancer in the United States;(1) b) recent legislative emphasis on rural healthcare equity initiatives;(2) c) pandemic-associated delays in cancer screening, diagnosis, and treatment(3)(,)(4) with resultant presentation of advanced oncologic stages; d) social spotlight on healthcare equity and inclusion for disenfranchised populations.(5) We will attempt to delineate these issues and propose widely applicable common-sense solutions. We will review what has transpired at the University of Kentucky over the last two decades, specifically at radiation oncology centre in Morehead, a clinic in eastern Kentucky in the Appalachian foothills. While much more work remains ahead, this clinic has successfully applied many of the initiatives discussed. FUNDING: No relevant funding of any research was involved in the preparation of data or the manuscript.