Disparities in Rural–Urban Cancer Care Outcomes Among Pediatric, Adolescent, and Young Adult Populations: A Comprehensive Narrative Review

Abstract

Pediatric cancer survival has improved substantially in recent decades; however, these gains remain unevenly distributed across populations. The National Cancer Institute has identified persistent disparities in pediatric cancer as a critical research priority, underscoring the need for focused investigation. This comprehensive narrative review examines the multifactorial contributors to rural–urban inequities in pediatric and adolescent and young adult (AYA) oncology. An extensive literature search of PubMed, Web of Science, SCOPUS, and the Cochrane Library identified English-language studies with data spanning 1973-2025 assessing disparities in rural cancer care and outcomes among U.S. children (ages 0-18 years) and AYA (ages 15-39 years). Compared with urban patients, rurality and long-distance travel to cancer care were often associated with poorer continuity of care, increased financial toxicity, reduced access to clinical trials, advanced therapies, and specialists, inadequate survivorship and supportive care, increased morbidity, and inferior survival. Disparities were further amplified among racial and ethnic minorities, who experienced decreased overall survival and increased early mortality across multiple cancer types. This review provides the first comprehensive synthesis of structural, geographic, and social drivers of rural cancer disparities and highlights multidisciplinary, evidence-based strategies to improve equitable access and outcomes for children and AYA living outside major urban centers.