The night before chemotherapy, Herlinda Sanchez lays out her clothes and checks that she has everything she needs: a blanket, medicine, an iPad and chargers, a small Bible and rosary, fuzzy socks and snacks for the road.
After the 36-year-old was diagnosed with stage 3 Lung cancer in December, she learned that there were no cancer services in her community of Del Rio, a city of 35,000 near the Texas-Mexico border.
To receive treatment, she and her husband, Manuel, must drive nearly three hours east to San Antonio. So they set an alarm for 4 a.m., which allows enough time to roll out of bed, brush their teeth, and begin the long journey navigating dark roads while watching deer.
About an hour before arriving at the cancer clinic, the couple stops for a quick bite to eat in the car. The break gives Herlinda time to apply ointment to the port where the needle will be inserted for her chemotherapy.
“It numbs the area, so when I get to the infusion room, the needle won’t hurt,” she said.
For rural patients, it has always been difficult to get cancer treatment close to home. But in recent years, chemotherapy deserts have expanded across the U.S., with 382 rural hospitals ceasing services from 2014 to 2022, according to a report released this spring by Chartis, a health consulting and analytics firm. .
Texas led that list, with 57 rural hospitals, nearly half of those statewide that had offered chemotherapy, cutting the service by 2022, according to the analysis. Rural hospitals in states like Texas, which has not expanded Medicaid, are more likely to close, according to data from the Cecil G. Sheps Center for Health Services Research.
To keep doors open, financially strapped facilities in small communities across the country continue to cut out basic health care services, such as obstetrics and chemotherapy, said Michael Topchik, executive director of the Chartis Center for Rural Health.
“The data is amazing,” Topchik said. “Can you imagine feeling this sick and having to drive an hour each way, or maybe more each way, several times a week?”
The loss of chemotherapy services may signal other gaps in cancer care, such as a shortage of local doctors and specialist nurses, which is bad news for patients, said Marquita Lewis-Thames, an assistant professor at Northwestern University of Chicago, whose research covers rural cancer care. .
Rural patients are less likely to survive at least five years after a cancer diagnosis compared to their urban counterparts, concluded a study co-authored by Lewis-Thames and published in JAMA Network Open in 2022. While the survival gap The rural-urban gap narrowed over the nearly 40 years the researchers studied, the disparity persisted across most racial and ethnic groups, with only a few exceptions, he said.
Lots of anti-cancer drugs are now given orally and can be taken at home, but some breast treatments, colon and other common cancers must still be administered intravenously within a medical facility. Even distances of an hour or two each way can strain patients who may already suffer from nausea, diarrhea and other side effects, doctors and patient advocates said.
“It’s quite uncomfortable for some of these patients who may have bone metastases or have significant muscle pain and have to sit in the car for so long and hit road bumps,” said Shivum Agarwal, a family physician. who practices in rural communities an hour west of Fort Worth, Texas.
Month, the trip can be expensive much more than filling the gas tank.
“It usually requires a family member without problems to take a full day or at least half a day off work,” Agarwal said. “So there’s a huge financial cost to the family.”
In this sense, the Sánchez family is lucky. Herlinda’s mother drives four hours from Abilene to Del Rio to see the couple’s youngest children, their 2-year-old twins.
Cancer infusions can take up to eight hours in addition to travel time, causing significant financial and logistical challenges, said Erin Ercoline, executive director of the San Antonio-based ThriveWell Cancer Foundation. The nonprofit organization offers financial assistance to adult patients, including for gaps in insurance and transportation-related costs. It has helped cover gas for Sanchez, who received his final round of chemotherapy in late June. The financial aid will also pay for her hotel when she travels for breast surgery in August.
Not all rural hospitals are ending chemotherapy. Childress Regional Medical Center, a 39-bed hospital in west Texas, is building a 6,000-square-foot center for patients who need infusions for cancer and other diagnoses, including multiple sclerosis and rheumatology.
The infusion area, which started with two chairs in 2013 and now has four, will grow to 10 chairs and have more patient privacy when it opens next year. The nearest infusion center in this sprawling region is an hour or more away, discouraging some patients from seeking care, said Holly Holcomb, Childress’ CEO.
“We’ve had a handful of patients say, ‘If you can’t do it here, I won’t do it,’” Holcomb said. She credits the federal 340B drug rebate program for allowing the remote hospital to provide infusion drugs.
Hospitals that qualify for 340B can purchase outpatient drugs at deep discounts. The program provides “great support for rural hospitals,” said Topchik of the Chartis Center. Hospitals can use the savings to boost or expand services provided in the community, he said.
But some patients are undeterred by long trips and travel costs.
“I’m from the country, smaller is better, it’s just nicer,” said Dennis Woodward, 69, who lives in Woodson, Texas. It has a type of non-Hodgkin’s lymphoma and opts for a two-hour drive to Childress. He had first visited an oncology clinic in Abilene an hour away. The doctors were nice, but “I felt like a number,” she said.
After his first appointment at Childress this year, his oncologist, Fred Hardwicke, brought him over to meet the nurses who would administer the drug, Woodward recalled.
Most Fridays during Herlinda Sánchez’s chemotherapy, Manuel napped in the car. But during his last treatment in June, he stayed close, counting down the hours.
Several family members joined Herlinda when she rang the bell later that afternoon to signal the end of her treatment.
“I don’t want to be in San Antonio anymore,” said Herlinda, a mother of four who does administrative work at Laughlin Air Force Base near Del Rio. “I’m looking forward to the break.”
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF — the independent source of health policy research, polling and journalism.…Read more by Yudathalla
