Evidence-based interventions to address rural cancer disparities: A systematic review and meta-analysis.
TL;DR
Evidence to reduce rural cancer disparities is concentrated in screening, with major gaps in treatment, survivorship, and end-of-life care, and future studies should prioritize later-stage implementation outcomes, including costs and sustainability.
Abstract
268 Background: Rural populations experience persistent disparities in the adoption of evidence-based practices (EBPs) across the cancer care continuum. This meta-analysis applied an implementation science lens to characterize interventions targeting rural cancer disparities, identify effective strategies, summarize implementation outcomes, and highlight research gaps. Methods: MEDLINE, Embase, Cochrane, and Scopus were systematically searched for U.S.-based interventional studies published from January 2010 to August 2025 that aimed to improve EBP adoption among rural populations. Two reviewers independently screened studies, extracted data, and evaluated the risk of bias with a third resolving discrepancies. The review followed the JBI guidelines and adhered to PRISMA guidelines. Random-effects meta-analyses were performed when sufficient data were available. Results: Of the 59,443 articles identified, 163 met the inclusion criteria. Overall, 42% were randomized controlled trials (RCTs), most commonly involving colorectal (48%), breast (26%), and cervical cancer (25%). No RCTs focused on lung cancer. Most RCTs focused on screening (77%), followed by survivorship (14%), prevention (6%), treatment (1%), and end-of-life (EOL) care (1%). Given the predominance of screening interventions, a meta-analysis of RCTs was performed on screening rates. Patient navigation (RR, 2.77, 95% CI, 2.24-3.41), multicomponent navigation interventions (RR 1.49, 1.27-1.75), multicomponent education (RR 1.87, 1.32-2.66), multicomponent reminders (RR 2.58,1.67-4.01), and combined patient-provider interventions (RR 2.11, 1.08-4.15) with increased screening uptake. Education alone (RR 1.20, 0.98-1.47) and reminders alone (RR 1.45, 0.86-2.45) were not associated with increased uptake. Beyond screening, evidence was sparse. Four prevention RCTs targeted HPV vaccination, one treatment RCT evaluated breast cancer treatment decision support, ten survivorship RCTs targeted physical activity, anxiety, QOL, and supportive care needs, and one EOL RCT evaluated coaching to improve goals-of-care discussions. Early implementation outcomes, including acceptability, adoption, appropriateness, feasibility, and fidelity, were reported in 59% of RCTs, whereas long-term outcomes were rarely assessed with only 16% assessing costs and none evaluating sustainability. Conclusions: Evidence to reduce rural cancer disparities is concentrated in screening, with major gaps in treatment, survivorship, and end-of-life care. Patient navigation and multicomponent interventions were most effective for increasing screening uptake. Future studies should prioritize later-stage implementation outcomes, including costs and sustainability, and expand intervention research to underrepresented areas of the cancer continuum and high-burden cancers such as lung cancer.