The Journey of Care for Rural Esophageal Cancer Patients

Background Rural esophageal cancer patients experience both fragmented and delayed care. One-size-fits-all interventions aimed at rural communities can be ineffective, as they can vary significantly in population, geographic isolation, and medical specialty availability. Therefore, as a rural health care center, we analyzed the journey of care for our esophageal cancer patients to better understand and serve our community. We aimed to create a framework for how to approach and analyze this complex care continuum for other small communities. Methods Esophageal cancer patients receiving care at a rural cancer center from September 2024 to April 2025 were enrolled. Care journeys were mapped from symptom onset through treatment. Interviews occurred at enrollment and 3 months. Results Twenty-seven patients were enrolled. Nearly half (48%) presented with metastatic disease. Patients on average reported symptoms 85 days after onset, were diagnosed 137 days after onset, and started treatment 48 day after diagnosis. Metastatic patients experienced shorter times to treatment (72 vs 128 days, P = 0.014) compared to locoregional patients. Surgical patients averaged 57 days from diagnosis to starting neoadjuvant treatment, followed by 97 days from completing neoadjuvant treatment to esophagectomy. Patients reported disempowerment, difficulty navigating the medical system, and a lack of awareness before diagnosis. Conclusions Rural esophageal cancer patients endure prolonged, fragmented, and variable care journeys. Surgical patients, in particular, face delays before esophagectomy. Rural research provides valuable insights for tailoring broader interventions for rural communities. In partnership, rural centers and universities provide both bottom-up and top-down perspectives in defragmenting rural esophageal cancer care.