Barriers to Surgical Colorectal Cancer Care in the Rural United States: A Scoping Review.

Abstract

Colorectal cancer is a leading cause of oncologic morbidity and mortality in the United States, with rural populations facing greater barriers when accessing high-quality surgical care compared to their urban counterparts. We aim to highlight the extent and nature of such inequities, better informing policy and guiding future research. Our search was conducted in CINAHL Complete (EBSCOhost), Embase (Elsevier), MEDLINE (PubMed), and Scopus (Elsevier) using keywords specific to colorectal cancer, surgical access, and rural populations in the United States. Articles included were original and focused on access to surgical services for rural colorectal cancer populations in the United States. Two reviewers independently conducted title and abstract screening, full-text review, and data extraction. All final articles were reviewed by the full authorship team before extraction. We aimed to outline the domains contributing to disparities in surgical access among rural colorectal cancer populations. Our search yielded 5218 unique citations, with 245 full-text articles assessed for inclusion. A total of 20 studies were included in the final synthesis. The review revealed that disparities in access to colorectal surgical care are influenced by critical overarching domains, including geographic barriers, the health care workforce, underlying patient socioeconomics, and regional demographics. Rural populations are highly heterogenous and each specific domain identified may have differing levels of impact within a specific community. Rural colorectal cancer populations face significant barriers to accessing surgical care compared to their urban counterparts across key domains. Policymakers should focus on measures to support rural health care systems and address workforce shortages to improve access and outcomes for underserved populations.