Navigating Rural Breast Cancer Care: Advocacy and Clinical Trial Access

For patients living in rural communities, the path to oncology care is often paved with obstacles that have little to do with biology and everything to do with geography. Research consistently shows that a shorter time to treatment is a critical factor in survival, yet for those facing significant travel restrictions or financial hurdles timely care can feel like an unreachable goal. In this interview, Dr. MinhTri Nguyen, a medical oncologist specializing in breast cancer, addresses the systemic and emotional barriers that prevent rural patients from accessing life-saving interventions.

Nguyen emphasized that the first hurdle is often internal: the shame patients may feel when they cannot meet the logistical demands of a rigorous treatment schedule. He argued that fostering an environment of radical transparency is essential. By speaking up early — whether to a physician, a nurse or a social worker — patients can unlock a network of support designed to dismantle these barriers. From patient navigator programs to localized resources, the goal is to ensure that a ZIP code does not determine a patient's prognosis.

The conversation also shifted toward patient empowerment in the realm of clinical trials. While the "educated patient" may feel hesitant to suggest a trial for fear of overstepping, Nguyen insisted that clinical trials are a viable answer at every stage of the treatment journey. He called for a shift in the medical vernacular, where asking about a trial becomes as standard as asking for a diagnosis.

By centering the patient in the decision-making process and addressing the nuances of rural healthcare, Nguyen provided a roadmap for more equitable oncology care.

CURE: You have found that shorter time to treatment is critical for survival, especially in rural populations. What advice do you have for patients who do live in rural areas, who do face travel restrictions or hurdles, and how they can get timely care?

Nguyen: This is a tough one because it's very culture- and behavioral-based, I think the first thing I'd like to say is we need to emphasize that this is common and it is a very normal feeling or situation to have. So, I sense that sometimes our patients who are in this situation feel like there's a lot of shame in stating this. I don't think that that should be the issue. I don't think that that you should feel shameful about saying, “I'm sorry, I just don't have the means or the transportation or the ability to do these things.”

But I think my recommendation to patients is speak up and speak up early. And it doesn't have to be so specific and so upfront immediately, just asking to see the social worker after your meeting with the physician, just asking if there's a patient navigator program, for instance. I think these things are ways that we can continue to have this conversation in more time. And I want that. I want patients to have the ability to have more time with the care team, and also have the ability to tell us about the nuances we talked about, the system issues of care.

And then there's the individualized issues I think that's important for me as a physician to know. So if you can reach my care team, or if you can reach me in another way, through the social worker, through a care navigator, through the nurse, these are ways I think that would help our patients feel better about revealing some of these hurdles, so that we can take down their hurdles.

And for a patient who hasn't been offered a trial but they are very interested, they've done their homework, they've done their research, they are the educated patient, how can they go about talking to their provider about a trial without feeling like they're overstepping when they should be a part of their decision making process?

The vast majority of physicians, oncologists, would never feel like you're overstepping if you're asking for a clinical trial. And a lot of that is because when you train, at least in America, it seems like a lot of these questions that you get on boards and whatnot, if there's an answer, choice of clinical trial likelihood, that's an answer. That is a very viable answer at every stage of the treatment journey. So, I don't think physicians really should feel in any way that there's any overstepping.

I will say that yes, the patients who are probably very well-read and really prepared, they will probably have no problem asking, because they did all of this. But even the patients who don't, I think what we need to do as a community is put it into the vernacular, so that it becomes just a very obvious question to ask in the same way as what is my diagnosis. It should come very easily for anyone, even those who haven't really read up on what a clinical trials is, that it becomes part of the vernacular for when you see patients that after diagnosis, what is my treatment? What is this? Does my treatment include clinical trials now or in the future? I think that is a very, really good thing just to say to your physician, period.

What are some of the best way for patients to advocate for themselves or resources to help them understand and navigate the complexities of a clinical trial?

It's difficult. You have to follow clinical trial protocols to a T and it becomes really burdensome for a patient to try to manage all of that on their own, especially if health literacy is not something that they're good with, when we conduct clinical trials. This is something that we have in mind. So patient navigation is something that experts and people who do clinical trials want to make sure that we have involved. So, when you are in a clinical trial, you should be assigned a nurse navigator, or someone who is attached to the clinical trial who can help answer questions along the way. I think patients should feel very comfortable reaching out to that team whenever they feel like they don't know what the next step is, or if they feel like they're confused about why they're doing this step. And that should be continuous communication.

Second to that is the care team. That is the team that would have taken care of them, even if they weren't on a clinical trial, that includes a physician, includes the nurse, APP, etc. They should also feel comfortable reaching out to them at any time. So I would say that nurse navigation and the navigation team, feel free to always reach out and, of course, the care team. We want patients to feel comfortable when they come into a clinical trial. Understanding everything is mandatory. We want patients to understand what they're doing, why they're doing it, because if they don't, then that's not appropriate, and that should not be the situation.

Transcript has been edited for clarity and conciseness.

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