Cancer disparities in Latinx communities of Western North Carolina and Appalachia: A scoping review of barriers and pathways to equity.

Abstract

e13754 Background: Appalachia experiences some of the highest cancer incidence and mortality rates in the United States. In Western North Carolina (WNC), rapid growth of Latinx communities—many employed in seasonal agricultural work—intersects with rural health inequities. However, cancer-related data specific to Latinx populations in Appalachia are often limited or obscured within broader geographic categories. We conducted a scoping review to characterize existing evidence on cancer prevention, screening, diagnosis, treatment, and survivorship among Latinx populations in WNC/Appalachia and comparable rural Appalachian regions, and to identify strategies to advance equity. Methods: Using PRISMA-ScR and Joanna Briggs Institute scoping review methodology, we will search MEDLINE/PubMed, Embase, CINAHL, Scopus, and gray literature for studies evaluating cancer-related outcomes or care processes among Latinx/Hispanic individuals residing in Appalachia, including WNC. Eligible studies will include quantitative, qualitative, and mixed-methods designs addressing any cancer type across the cancer continuum. Two reviewers will independently screen studies and extract data on population characteristics, rurality, cancer site, outcomes, barriers, facilitators, and interventions. Findings will be categorized using multilevel frameworks and summarized descriptively. Results: Preliminary mapping demonstrates a limited evidence base focused on rural Appalachian Latinx communities. Recurrent multilevel barriers include: (1) structural factors such as unstable insurance coverage, concerns related to documentation status, limited access to oncology services, and transportation challenges; (2) work-related constraints among farmworkers, including seasonal migration and inflexible schedules; (3) language and cultural barriers, including limited English proficiency, low health literacy, stigma, and lack of Spanish-language services; and (4) inequities in care processes, such as delays in diagnosis and treatment, incomplete follow-up after abnormal screening results, and underrepresentation in research. Interventions reported in similar rural Latinx settings include community health worker navigation, culturally tailored education in trusted community venues, mobile health services, and telehealth-based specialist collaboration models. Conclusions: Improving cancer equity for Latinx communities in WNC and Appalachia will require more granular surveillance that disaggregates ethnicity within rural cancer data and the implementation of evidence-informed, community-engaged care models. This scoping review will identify gaps in the literature and inform region-specific interventions and policy efforts aimed at reducing late-stage diagnoses and disparities in access to timely cancer care.