Access to care, behavioral risk factors contribute to West Virginia’s cancer disparities

West Virginians die of cancer at a higher rate than the rest of the United States. The reasons for that disparity were the focus of a virtual conversation hosted by the FDA Oncology Center of Excellence. 

Tuesday’s episode of Conversations on Cancer – Cancer Disparities in Appalachia featured comments from local health professionals and cancer survivors. 

According to data from the state Department of Health and Human Resources and the U.S. Centers for Disease Control and Prevention, West Virginia’s cancer mortality rate was 184.2 per 100,000 people in 2021, compared with 146.6 per 100,000 nationally. The mortality rate for 2022 is not yet finalized, according to the state Department of Health and Human Resources. 

“We know that the zip code where we live is as important as the DNA we have in our cells in determining health outcomes,” said Stephanie Kennedy Rea, associate director for cancer prevention and control at the WVU Cancer Institute. “We’re talking about a rural Appalachian state. We’re talking about a state with low population density, and that presents many problems with access.”

According to the state’s 2020 Cancer Burden Report, West Virginia’s cancer mortality rate was 194.1 per 100,000 in 2014 and has dropped or stayed the same every year through 2019, when it was 173.7. The mortality rate increased to 177 per 100,000 in 2020 and to 184.2 in 2021 according to the Health Statistics Center. 

Access to health care and transportation, as well as a primary care physician shortage in most West Virginia counties, are among the issues that affect the disparity, Kennedy Rae said. In addition, the state’s poverty — an estimated 16.8 percent in 2022 — also affects access to nutritious food and clean water, education level and infrastructure, she said. 

In addition, services are usually set up in larger population centers, she said. The majority of West Virginians live in communities of less than 2,500 people. 

“Time to screening and time to treatment — all those things are complicated by our rurality and geography,” Kennedy Rea said. 

Increasing uninsured rates and the state’s behavioral risk factors — including high rates of smoking and obesity and low rates of the HPV vaccine participation are also factors, she said.

Breast cancer survivor Patricia Davis, of Romney, spoke of the lack of access to health care in her community when she was diagnosed 24 years ago.

“I was diagnosed and all of a sudden it was like ‘Where am I going to get treatment? There’s no treatment near me,’” she said. “I would have to travel 45 miles to Winchester, Virginia, or I would have to drive 25 miles to Cumberland, Maryland. So traveling was an issue.”

The conversation also focused on increasing state residents’ participation in clinical trials.

Heather Foster, of Parkersburg, spoke of participating in an immunotherapy clinical trial for triple negative breast cancer that she said saved her life. Foster said she first noticed a lump in March 2020, as the “whole world was shutting down” because of COVID-19. She was accepted into the trial and then started treatment that August. 

“Thankfully I was in a clinical trial … it was a double blind clinical trial but I know that I received [the drug] because I’m still here,” she said. 

Bhavana “Tina” Bhatnagar, director of hematology and medical oncology at the WVU Cancer Institute at Wheeling Hospital, said national rates of participation in clinical trials is low, but the participation rate is lower in Appalachia for a number of reasons, she said. 

According to the National Library of Medicine, about 5% of Americans have participated in a clinical trial as of 2020. People with lower education and less clinical trial knowledge are among those who are less likely to participate. 

Barriers include a “knowledge gap” about the trials and a perception that people are used as “guinea pigs,” as well as distance to the center where the studies may take place, Bhatnagar said. 

“Clinical trials have a lot of eligibility criteria and a lot of requirements to be on study and quite honestly, people cannot always afford to comply with those requirements, which I think sometimes is a barrier for enrollment,” she said. “So those are just a couple of things.”