Unequal paths to care: a scoping review of access and cancer outcomes in Alabama

Abstract Purpose Alabama experiences some of the highest cancer incidence and mortality rates in the USA. Black and rural residents experience a disproportionate burden of cancer disparities, driven by geographic isolation, financial hardship, limited insurance coverage, and fragmented healthcare systems, all of which impede timely access to cancer prevention, treatment, survivorship, and palliative care services. This scoping review synthesizes historical and contemporary research describing barriers and access to cancer care among residents of Alabama across the cancer care continuum using Robinson and Hudson’s Inter-relationships Framework. Methods Guided by the PRISMA-ScR reporting and Joanna Briggs Institute methodologies, we searched MEDLINE, Embase, Scopus, CINAHL, and APA PsycINFO for peer-reviewed studies published between January 1, 1995, and December 30, 2024. Two reviewers independently screened articles and extracted data using a four-stage extraction and verification process. Critical appraisal was conducted using JBI tools to contextualize study quality; no studies were excluded based on appraisal scores. Results A total of 28 studies met criteria, involving Black, rural, and older adults in Alabama. Barriers to cancer care occurred at multiple levels. Patient-level barriers included financial hardship, travel burden, and insurance limitations. Provider-level influences included communication quality, cultural responsiveness, and continuity of care. System-level barriers included rural healthcare workforce shortages, concentration of specialty care in urban centers, and the absence of Medicaid expansion. Lay navigation and telehealth-based symptom monitoring demonstrated promise in improving access and continuity of care. Conclusion Access to cancer care in Alabama is influenced by patient, provider, and system-level factors. Sustainable progress will require coordinated efforts that expand insurance coverage, strengthen rural healthcare infrastructure, and adopt culturally responsive, culturally centered cancer care delivery models. Implications for Cancer Survivors Accessible healthcare is critical to achieve timely diagnosis, deliver appropriate treatments, and provide necessary supportive care to cancer survivors in under-resourced areas.