# Rural Perceptions of Tumor Treating Fields for Glioblastoma: A Cross-Sectional Survey

## TL;DR

This study explores how rural residents perceive a non-invasive brain cancer treatment called Tumor Treating Fields, finding that awareness and adoption are limited by cost, access, and education gaps.

## Contribution

The study provides new insights into rural perceptions and barriers to adopting Tumor Treating Fields for glioblastoma, highlighting the need for targeted educational and policy interventions.

## Key findings

- High cost (65%) and limited access (55%) are major barriers to TTF adoption in rural areas.
- Education level significantly influences awareness and willingness to adopt TTF (p = 0.024 and p = 0.012).
- Targeted educational initiatives and policy measures are needed to improve access to advanced neuro-oncology therapies.

## Abstract

Introduction

Glioblastoma (GBM) is an aggressive primary brain tumor with limited treatment options and poor prognosis. Tumor treating fields (TTFs) are described as non-invasive because they do not require surgery and have practical demands - such as continuous wear for 23 hours per day, head shaving, and managing heavy batteries - that limit daily activities and may affect therapy acceptance. These challenges complicate its classification as truly non-invasive. Awareness and adoption of TTF in rural communities remain poorly understood due to disparities in healthcare access and education. This study investigates rural perceptions of TTF, focusing on awareness, barriers, and willingness to adopt the treatment, aiming to inform educational initiatives and improve access to innovative therapies in underserved areas.

Materials and methods

A cross-sectional survey was conducted among rural Michigan residents living over 50 miles from comprehensive cancer centers, such as the University of Michigan Rogel Cancer Center and Karmanos Cancer Institute. Participants aged 18 or older who resided in rural Michigan and identified as patients, caregivers, or community members interested in GBM care were included, while those with professional oncology experience were excluded to avoid bias. Data on awareness, perceived barriers (e.g., cost, access), and willingness to adopt TTF were collected through anonymous surveys. Quantitative data were analyzed using descriptive statistics and the Kruskal-Wallis test, while qualitative responses underwent thematic coding. Ethics approval was not required, and informed consent was implied upon survey completion.

Results

The survey assessed awareness, perceived barriers, and willingness to adopt TTF among rural Michigan residents residing over 50 miles from comprehensive cancer centers. Awareness was measured using a 5-point Likert Scale and categorized into binary groups of "aware" and "unaware" for analysis. Barriers such as high cost (78 of 120; 65%), limited access to care (66 of 120; 55%), and lack of understanding (60 of 120; 50%) were identified. The Kruskal-Wallis test revealed significant differences in awareness (p = 0.024) and willingness to adopt TTF (p = 0.012) based on education level, but no significant differences by age (p = 0.413) or gender (p = 0.521). These findings underscore the need for targeted educational interventions and policy measures to improve equitable access to advanced neuro-oncology therapies in underserved communities.

Conclusions

Rural communities face significant challenges in accessing and understanding advanced treatments like TTF for GBM, driven by financial, educational, and geographic barriers. Targeted educational efforts, improved access to care, and supportive interventions are critical for addressing these disparities. Engaging healthcare providers to foster trust and disseminate information could play a pivotal role in bridging the gap. This study underscores the importance of tailored educational initiatives, policy-driven solutions, and healthcare provider engagement to improve equitable access to innovative neuro-oncology therapies. Addressing these barriers is vital to reducing healthcare disparities and enhancing outcomes for underserved populations.