Cost and Access Barriers Burden Patients in Rural Areas, ACS Survey Finds

More than half of patients with cancer and cancer survivors living in rural communities report difficulty affording their cancer care, ultimately hindering care access and utilization, according to a survey by the American Cancer Society Cancer Action Network (ACS CAN).^1,2 The findings, drawn from the organization’s Survivor Views research panel, underscore the compounding financial and logistical obstacles that rural patients face.

From March 17 to April 7, 2026, the web-based survey collected responses from a total of 1436 patients and survivors nationwide who had been diagnosed with or treated for cancer in the last 7 years, including 483 residing in rural communities. Of those living in rural areas, 53% reported difficulty affording cancer care, half have incurred medical debt related to those costs, and 70% expressed concern about incurring new medical debt as a result of their cancer care.

The Downstream Consequences of Debt

The downstream consequences of that debt burden are significant. Among rural respondents who reported cancer-related medical debt, 44% have been contacted by a collections agency, and 39% said their credit score has been negatively affected. Nine percent have filed or considered filing for bankruptcy due to the costs of their cancer care. Twenty-three percent have skipped or delayed recommended medical care, and an equal proportion have skipped or delayed taking a prescribed medication due to difficulty paying for it.

Cost is also influencing treatment decision-making at the point of care. One in 10 rural patients said the expected cost is the most important factor when a provider recommends a treatment, procedure, or test, while another 35% said cost is among the factors they consider. These figures stress the importance of routine financial toxicity screening and early referral to financial navigation resources before initiating or modifying a treatment plan.

Food insecurity is another consequence of treatment-related costs. Forty-four percent of rural patients and survivors said the cost of their cancer care has at some point impacted their ability to purchase food. This level of material hardship—a recognized social determinant of health—can compromise treatment adherence and overall well-being.

The Rural Disconnect: Access and Travel Barriers

Structural disadvantages in outcomes among rural patients with cancer have been well-documented in previous reports. According to the ACS 2025 report on cancer disparities, overall cancer mortality is higher in nonmetropolitan than in large metropolitan counties, with the gap widest for lung cancer (45% higher) and cervical cancer (36% higher).³ Longitudinal analyses of national mortality trends further show that all-cancer mortality rates have been consistently higher in rural than in urban populations since the 1990s and early 2000s, with urban-rural gaps widening in the following years.⁴

The present ACS CAN survey quantifies these disparities in practice. Thirty-eight percent of rural respondents reported difficulty finding in-network providers—a rate 10 percentage points higher than patients nationwide—and 23% have experienced delays due to health care workforce shortages in their area. Travel burden adds another layer of difficulty: traveling long distances to specialists was rated the most difficult challenge by 45% of rural respondents, and costs of travel (41%) and time away from work or family (40%) followed closely. More than a third (37%) travel over an hour to reach their primary oncology provider, and 34% have had to sleep away from home during treatment, with 61% of those paying for lodging themselves. One in 5 worried that travel demands might cost them their job or their health coverage; that figure rises to 35% among those who were employed during treatment.

Policy and Patient Navigation as a Mitigation Strategy

While 74% of rural respondents rated local care quality as excellent or good, significantly below the 88% reported by suburban residents, those with access to a patient navigator reported fewer barriers and higher quality ratings across the board. Among patients with a navigator, 49% believed their community's care quality exceeded the national average. Currently, about half (51%) of rural patients report that their primary oncology provider has a dedicated navigator on staff, leaving roughly half of this population without that support.

The policy landscape around patient navigation in the United States has shifted recently, broadening access to navigation services to patients with cancer. Effective January 1, 2024, the Centers for Medicare and Medicaid Services (CMS) issued a final rule formally recognizing patient navigation as a reimbursable service for eligible patients with serious, high-risk conditions including cancer under Medicare Part B.⁵ ACS CAN has called on policymakers to build on this foundation through sustained federal funding for navigation programs and expanded workforce investment in rural health care.

“When facing a cancer diagnosis, where you live shouldn’t determine if you live,” said Lisa A. Lacasse, president of ACS CAN, in a news release.¹ “This survey underscores the need to advance policy solutions that will help improve access to high quality, affordable health care, such as sustainable funding for patient navigation services, among other interventions. This will help reduce the cancer burden for everyone, no matter where they live.”

REFERENCES

1. New ACS CAN Survey Finds More than Half of Cancer Patients and Survivors in Rural Communities Report Difficulty Affording Cancer Care. News release. American Cancer Society Cancer Action Network. May 13, 2026. Accessed May 15, 2026. https://tinyurl.com/ydnczwx9

2. American Cancer Society Cancer Action Network. Survivor views on rural health. Published May 13, 2026. Accessed May 15, 2026. https://tinyurl.com/496kuya9

3. New ACS Cancer Disparities Report: Major Differences Persist in Mortality Burden by Urbanicity, Congressional District, Socioeconomic Status, and Race/Ethnicity. News release. American Cancer Society. December 16, 2025. Accessed May 15, 2026. https://tinyurl.com/58ysnnyu

4. 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. Published online March 19, 2026. doi:10.1093/jnci/djag047

5. Principal illness navigation services. US Centers for Medicare and Medicaid Services. Published 2026. Accessed May 15, 2026. https://tinyurl.com/2f7rpb24