Leveraging the RUCA Tool to Address Geographic Disparities in Cancer Care: A Dual-Application Framework for Institutional and National Initiatives

Citation

Adams MCB, Hudson CL, Perkins ML, Hurley RW, Topaloglu U. Leveraging the Rural-Urban Commuting Area Tool to Address Geographic Disparities in Cancer Care: A Dual-Application Framework for Institutional and National Initiatives. JCO Clin Cancer Inform. 2025 Nov;9:e2500122. doi: 10.1200/CCI-25-00122. Epub 2025 Nov 7. PMID: 41202192; PMCID: PMC12614380.

Article Type

Original Research

Topic Area

Health Services Research; Policy and Health Systems

Population

Cancer patient populations at institutional and national levels; Rural-Urban Commuting Area (RUCA) geographic data

Summary

Geographic disparities in cancer care access and outcomes remain a persistent challenge in the United States, particularly for patients residing in rural areas. This study describes the development and application of a dual-framework approach using Rural-Urban Commuting Area (RUCA) codes to identify and address geographic disparities at both institutional and national levels. The authors demonstrate how RUCA-based geographic classification can be applied to institutional cancer registry data to characterize the rurality of patient populations served, and how the same framework can be scaled to national datasets to identify disparities across the cancer care continuum. The approach provides health systems and research networks with a standardized methodology for assessing geographic access to cancer care services, which has implications for resource allocation, outreach program design, and health policy. Although focused on cancer, the framework is directly applicable to chronic pain and opioid use disorder research, where rural populations face similar barriers to accessing evidence-based treatments. The study demonstrates the value of standardized geographic tools in health services research for identifying underserved populations and informing equitable care delivery.

Background

Rural populations in the United States experience significant disparities in cancer screening, treatment, and survival. RUCA codes provide a census tract-level classification system for rurality that is more granular than county-level designations. However, practical frameworks for applying RUCA codes in health services research and institutional quality improvement have been limited.

Methods

The authors developed a dual-application framework that applies RUCA codes at two levels: institutional, using cancer registry data to characterize the geographic distribution of patients served, and national, using population-level datasets to identify disparities. The framework was validated using institutional data and national cancer incidence and outcome data.

Key Findings

The RUCA-based framework successfully identified geographic disparities in cancer care at both institutional and national levels. The approach revealed underserved rural areas within institutional catchment regions and national-level variations in cancer outcomes associated with rurality. The methodology proved adaptable across different data sources and institutional contexts.

Implications for Practice and Policy

Standardized geographic classification using RUCA codes can help health systems target outreach and resource allocation to underserved rural populations. For policy makers, the framework supports evidence-based decisions about where to invest in cancer care infrastructure, telemedicine, and community health programs, with parallel applications for pain management and substance use treatment access.

Keywords

geographic disparities, RUCA codes, cancer care, rural health, health equity, health services research, care access, rural-urban classification, pain medicine, opioid use disorder