54 MAR / APR 2020 I HEALTHCARE JOURNAL OF ARKANSAS DIALOGUE COLUMN ONCOLOGY 42 percent of Arkansans live in a rural county, compared with 15 percent nationwide. Be- tween the 502 incorporated municipalities in our state, we have communities whose populations range from 201,244 in Little Rock to 28 in Gilbert. We have metropolitan areas equipped withmultiple hospital systems and dozens of specialized clinics, and we have small rural towns whose roster of medical providers is nonexistent or fits on the first page of a Google search. Access to medical care is so incredibly varied across our state, but the health outlook and quality of life for the residents of these communities should not be negatively impacted because of this variance. Monica M. Bertagnolli, MD, FACS, FASCO, Chief, Division of Surgical Oncology, Brigham and Women’s Hospital, says that “while 19 percent of the U.S. population resides in rural areas, just 6 percent to 7 percent of oncology practices have a practice that includes a rural area, creating an access to care issue among older, sicker, and poorer populations.” When a community does not have a facil- ity or provider dedicated to cancer care, their residents suffer. The residents who are al- ready battling other barriers, including finan- cial and transportation limitations that may hinder them from being able to seek treat- ment in an outside community, do not even have an option within their own community to visit. With limited access to quality pre- ventive screenings and treatment, patients living in these areas often go undiagnosed, or if they do receive a diagnosis, it is often at a FROM 2013 to 2017, Arkansas had the fourth highest rate of deaths from cancer. It is es- timated that in 2020, 17,200 Arkansans will receive a new cancer diagnosis. We believe these statistics are not all encompassing, and that thousands more are living with undiag- nosed cancer because of barriers that prevent them from seeing a doctor. What are the most common barriers?The two most commonly stated are a lack of ac- cess and education—two resounding issues prevalent in rural communities, both in our state, and across the country. Drilling down into the access factor further, especially when it comes to cancer services, many patients will make a drive if they feel the traveled dis- tance is worth it for care they can trust. According to recent population estimates, THE FUTURE OF ONCOLOGY: Community-Based Cancer Care The latest Annual Report to the Nation on the Status of Cancer revealed that the cancer death rate has dropped 27 percent over the last 25 years. While that is very positive news nationally, the report for Arkansas is not as positive. Our rates of cancer incidence and death are actually on the rise.