{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:12:09Z","timestamp":1790021529014,"version":"4.0.1"},"reference-count":66,"publisher":"American Society of Clinical Oncology (ASCO)","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Oncol Pract"],"abstract":"<jats:p>Rural Americans with cancer face persistent and widening disparities in incidence, stage at diagnosis, treatment access, and mortality. This paper synthesizes evidence on the financial sustainability of rural oncology programs, the populations bearing the greatest burden of rural cancer disparities, and the care delivery models most likely to narrow those gaps. We conducted a narrative review of English-language literature published through early 2026, drawing from peer-reviewed articles, national surveillance data, ASCO abstracts, and policy analyses. Rural oncology programs face significant financial challenges: 85% of rural hospitals are strained or vulnerable, cancer services at critical access hospitals (CAHs) have declined, and the 340B Drug Pricing Program's orphan-drug exclusion for CAHs represents an underappreciated structural gap that undermines program sustainability for the facilities most dependent on it. Rural-urban cancer mortality gaps are widest among adults younger than 65 years (the age paradox), who lack Medicare's partial safety net. Racial and ethnic minorities in rural areas, particularly Black Americans and American Indian\/Alaska Natives, face compounding geographic and structural barriers. Counter to longstanding assumptions, the per-capita supply of rural oncologists grew approximately 20% nationally from 2012 to 2022, with 67% growth in the most isolated areas. Several models show promise, including hub-and-spoke networks, teleoncology, Project Extension for Community Healthcare Outcomes (ECHO) telementoring, CAH-based programs, patient navigation, oncology hospital-at-home, and National Cancer Institute Community Oncology Research Program (NCORP) sites. However, a key paradox persists: regions with the poorest geographic access to cancer centers have the lowest telehealth utilization rates. Rural cancer disparities are fundamentally a policy and equity problem, not a technology or geography problem. Proven delivery models exist, but they require concurrent policy investment to realize their full potential. Closing the gap requires permanent telehealth authorization, with payment parity, Medicaid expansion, advanced practice provider workforce investment, targeted 340B reform for CAHs, and interstate licensure reform. Oncologists and health systems have both the evidence and the ethical obligation to advocate for these changes, including through participation in hub-and-spoke affiliate networks, NCORP sites, or ECHO programs in their own communities.<\/jats:p>","DOI":"10.1200\/op-26-00440","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:59:16Z","timestamp":1790020756000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Rural Cancer Care Delivery in the United States: A 2026 Update on Disparities, Vulnerable Populations, and Emerging Models"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2121-7917","authenticated-orcid":true,"given":"Wade","family":"Swenson","sequence":"first","affiliation":[{"name":"Rural Cancer Institute, Staples, MN"},{"name":"Lakewood Health System, Staples, MN"},{"name":"Internal Medicine, Burnett School of Medicine at TCU, Fort Worth, TX"},{"name":"Internal Medicine, University of North Dakota School of Medicine, Grand Forks, ND"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9899-117X","authenticated-orcid":true,"given":"Zachary","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Rural Cancer Institute, Staples, MN"},{"name":"Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_3_4_2_2","first-page":"e70045","article-title":"American cancer society's report on the status of cancer disparities in the United States, 2025","volume":"76","author":"Islami F","year":"2026","unstructured":"Islami F, Arias G, Lee D, et al: American cancer society's report on the status of cancer disparities in the United States, 2025. CA Cancer J Clin 76:e70045, 2026","journal-title":"CA Cancer J Clin"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.22.00704"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.70006"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.70060"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.01545"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2022.01640"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001635"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12716"},{"key":"e_1_3_4_10_2","volume-title":"Orphan Drug Exclusion. HRSA 340B Drug Pricing Program","author":"Health Resources & Services Administration","unstructured":"Health Resources & Services Administration: Orphan Drug Exclusion. HRSA 340B Drug Pricing Program. https:\/\/www.hrsa.gov\/opa\/program-requirements\/orphan-drug-exclusion"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bmc.2023.117170"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac038"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.70073"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2025.43.16_suppl.e13738"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/10732748241261558"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33498"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70032-9"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2021.106741"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1158\/1940-6207.CAPR-24-0587"},{"key":"e_1_3_4_20_2","first-page":"e13680","article-title":"The role of income and rurality in US cancer mortality: A SEER analysis","volume":"43","author":"Farrow NE","year":"2025","unstructured":"Farrow NE, Siddiqui ZA, Wang D, et al: The role of income and rurality in US cancer mortality: A SEER analysis. J Clin Oncol 43:e13680, 2025 (suppl 16)","journal-title":"J Clin Oncol"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2023.101505"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.70004"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-24-0072"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.22.00122"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","unstructured":"Nicholson B Sloss EA Fausett A et al: Rural access to the cancer hospital at home care model. NEJM Catal Innov Care Deliv 5:10.1056\/CAT.23.0336 2024","DOI":"10.1056\/CAT.23.0336"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000001273"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/00031348241312124"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33667"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.31520"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31704"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.28209"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-22-0943"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.873642"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers18030398"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.35355"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.20.00174"},{"key":"e_1_3_4_37_2","volume-title":"Supply, Distribution, and Access to Cardiologists, Neurologists, Oncologists, and Pulmonologists in the Rural and Urban U.S. Policy Report. WWAMI Rural Health Research Center","author":"Burchim SE","year":"2025","unstructured":"Burchim SE, Evans DV, Maris NL, et al: Supply, Distribution, and Access to Cardiologists, Neurologists, Oncologists, and Pulmonologists in the Rural and Urban U.S. Policy Report. WWAMI Rural Health Research Center. University of Washington, 2025. https:\/\/familymedicine.uw.edu\/rhrc\/wp-content\/uploads\/sites\/4\/2025\/08\/RHRC_PRAUG2025_Burchim.pdf"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-025-02070-8"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.22.00455"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000001913"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.35616"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2025.43.16_suppl.e13887"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.2196\/79956"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP-24-00751"},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13187-023-02292-x"},{"key":"e_1_3_4_46_2","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12682"},{"key":"e_1_3_4_47_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2025.43.16_suppl.4051"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.6337"},{"key":"e_1_3_4_49_2","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000004749"},{"key":"e_1_3_4_50_2","first-page":"633","article-title":"Challenges of rural cancer care in the United States","volume":"29","author":"Charlton M","year":"2015","unstructured":"Charlton M, Schlichting J, Chioreso C, et al: Challenges of rural cancer care in the United States. Oncology (Williston Park) 29:633-640, 2015","journal-title":"Oncology (Williston Park)"},{"key":"e_1_3_4_51_2","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.23.0344"},{"key":"e_1_3_4_52_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.03609"},{"key":"e_1_3_4_53_2","volume-title":"ARPA-H works to deliver advanced hospital-level care to rural areas: PARADIGM awardees announced","author":"Advanced Research Projects Agency for Health (ARPA-H)","year":"2025","unstructured":"Advanced Research Projects Agency for Health (ARPA-H): ARPA-H works to deliver advanced hospital-level care to rural areas: PARADIGM awardees announced. ARPA-H, 2025. https:\/\/arpa-h.gov\/news-and-events\/arpa-h-works-deliver-advanced-hospital-level-care-rural-areas"},{"key":"e_1_3_4_54_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.1590"},{"key":"e_1_3_4_55_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28033"},{"key":"e_1_3_4_56_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.0928"},{"key":"e_1_3_4_57_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djz234"},{"key":"e_1_3_4_58_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2025.43.16_suppl.1523"},{"key":"e_1_3_4_59_2","doi-asserted-by":"publisher","DOI":"10.1093\/oncolo\/oyag118"},{"key":"e_1_3_4_60_2","doi-asserted-by":"publisher","DOI":"10.21037\/jhmhp-25-83"},{"key":"e_1_3_4_61_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-023-01447-5"},{"key":"e_1_3_4_62_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.02683"},{"key":"e_1_3_4_63_2","article-title":"Long-term trends in cancer mortality by rural-urban status, United States, 1969-2023","author":"Islami F","unstructured":"Islami F, Zahnd WE, Wiese D, et al: Long-term trends in cancer mortality by rural-urban status, United States, 1969-2023. J Natl Cancer Inst 10.1093\/jnci\/djag047 [epub ahead of print on March 19, 2026]","journal-title":"J Natl Cancer Inst"},{"key":"e_1_3_4_64_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-17-0430"},{"key":"e_1_3_4_65_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2024.06.002"},{"key":"e_1_3_4_66_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gore.2021.100868"},{"key":"e_1_3_4_67_2","doi-asserted-by":"publisher","DOI":"10.1188\/13.ONF.575-580"}],"container-title":["JCO Oncology Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/OP-26-00440","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:59:19Z","timestamp":1790020759000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/OP-26-00440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":66,"alternative-id":["10.1200\/OP-26-00440"],"URL":"https:\/\/doi.org\/10.1200\/op-26-00440","relation":{},"ISSN":["2688-1527","2688-1535"],"issn-type":[{"value":"2688-1527","type":"print"},{"value":"2688-1535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]},"assertion":[{"value":"2026-04-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-04","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"OP-26-00440"}}