Date of Award


Document Type

Open Access Dissertation


Health Services and Policy Management


The Norman J. Arnold School of Public Health

First Advisor

Saundra H. Glover


Introduction: Lung cancer is a high pain cancer that can require the attention of clinical specialists. Already vulnerable populations, like those that inhabit rural areas, when dealing with chronic diseases, like lung cancer, need and deserve adequate medical attention. However, rural communities often lack clinical specialists and are left without the needed care. It is necessary to investigate the current availability of treatment options (medications) available to cancer patients in rural communities. Gaining this knowledge can result in economic savings and improvement of the quality of life for rural populations.

Methods: Medicaid data from 1996-2010 was used to examine geographical disparities (urban and rural) in the state of South Carolina. Medicaid recipients identified as distant stage lung cancer patients were linked with data from the South Carolina Cancer Registry. All patients included in the sample were either prescribed an opioid or analgesic and were continuously enrolled in Medicaid for at least 9 months prior to diagnosis (N=1,334). Using the weighted data, logistic regression and Cox Proportional Hazard analyses were performed to assess the likelihood of disparate health care treatment and the survival rate of patients in the sample.

Results: Findings of the conducted logistic regression were not statistically significant. This indicates that none of the variables analyzed in the patient factor or structure and process of care components were directly associated with patient receipt of medications. For the Cox Proportional Hazard model, gender was the only statistically significant variable that emerged from the model. Males (OR=1.31, CI: 1.03-1.65) were more likely than females to experience cancer-related death than females. Considering patient and provider geography, there was a greater presence of cancer specialists in the urban areas of South Carolina. The deficit of clinical resources referred to a lack of cancer specialists to treat and prescribe medications appropriately as well as pharmacies to fill prescriptions. Each having the potential to impact the manner of health care treatment as well as influence the longevity of a patient’s life.

Conclusion: The disparities in access to care in the urban and rural regions of South Carolina indicate the need for policy that improves the availability of specialty clinicians in rural areas as well as rural residents’ access to pain medications. With proper regulatory stipulations in place, the concerns of substance diversion and dependence would decrease. The development of local and federal government policy is necessary to increase the degree of pain control among these populations.