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Patients in small towns encounter significant obstacles as rural hospitals reduce cancer treatment options

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The night time earlier than her chemotherapy, Herlinda Sanchez units out her garments and checks that she has all the things she wants: a blanket, drugs, an iPad and chargers, a small Bible and rosary, fuzzy socks, and snacks for the street.

After the 36-year-old was recognized with stage 3 breast cancer in December, she realized that there weren’t any most cancers companies in her group of Del Rio, a city of 35,000 close to the Texas-Mexico border.

To get therapy, she and her husband, Manuel, should drive almost three hours east to San Antonio. In order that they set an alarm for 4 a.m., which permits for simply sufficient time to roll off the bed, brush their enamel, and start the lengthy drive navigating darkish roads whereas awaiting deer.

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Herlinda Sanchez heads again to her automobile together with her husband, Manuel, after her last chemotherapy appointment at Texas Oncology.
Lisa Krantz for KFF Well being Information

About an hour earlier than they arrive on the most cancers clinic, the couple pulls over to shortly eat quick meals within the automobile. The break offers Herlinda time to use ointment on the port the place the needle for her chemotherapy can be inserted.

“It numbs the world, so after I get to the infusion room, the needle will not damage,” she stated.

For rural sufferers, getting most cancers therapy near house has all the time been troublesome. However in recent times, chemotherapy deserts have expanded throughout america, with 382 rural hospitals halting services from 2014 to 2022, in accordance with a report revealed this spring by Chartis, a well being analytics and consulting agency.

Texas led that listing, with 57 rural hospitals — almost half of these statewide that had supplied chemotherapy — chopping the service by 2022, in accordance with the evaluation. Rural hospitals in states like Texas, which hasn’t expanded Medicaid, have been extra more likely to shut, in accordance with knowledge from the Cecil G. Sheps Middle for Well being Companies Analysis.

To maintain the doorways open, financially strapped facilities in small communities nationwide proceed to shed primary well being care companies, like obstetrics and chemotherapy, stated Michael Topchik, govt director of the Chartis Middle for Rural Well being.

“The information are staggering,” Topchik stated. “Are you able to think about feeling that sick and having to drive an hour in every route, or possibly extra every route, a number of instances every week?”

Lack of chemotherapy companies can sign different gaps in most cancers care, akin to a scarcity of native specialty physicians and nurses, which is dangerous information for sufferers, stated Marquita Lewis-Thames, an assistant professor at Northwestern College in Chicago whose analysis covers rural most cancers care.

Rural sufferers are much less more likely to survive not less than 5 years after a most cancers analysis in contrast with their city counterparts, concluded a study co-authored by Lewis-Thames and revealed in JAMA Community Open in 2022. Whereas the rural-urban survival hole narrowed over the almost 40 years researchers studied, the disparity persevered throughout most racial and ethnic teams, with just a few exceptions, she stated.

Many cancer drugs at the moment are given orally and will be taken at house, however some remedies for breast, colon and different frequent cancers should nonetheless be administered intravenously inside a medical facility. Even distances of an hour or two every approach can pressure sufferers who already could also be dealing with nausea, diarrhea, and different unwanted side effects, physicians and affected person advocates stated.

“It is fairly uncomfortable for a few of these sufferers who could have bone metastases or have vital muscular ache and have to take a seat within the automobile that lengthy and hit street bumps,” stated Shivum Agarwal, a household doctor who practices in rural communities an hour west of Fort Value, Texas.

Plus, travel can cost far more than filling the fuel tank.

“Often, it requires an able-bodied member of the family taking off a complete day or not less than half a day from work,” Agarwal stated. “So, there is a large financial value for the household.”

On this sense, the Sanchez household is lucky. Herlinda’s mom drives 4 hours from Abilene to Del Rio to observe the couple’s youngest kids, their 2-year-old twins.

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Herlinda Sanchez has been making the almost three-hour drive from her house in Del Rio, Texas, to San Antonio for chemotherapy remedies at Texas Oncology.
Lisa Krantz for KFF Well being Information

Most cancers infusions can final so long as eight hours on prime of the journey time, inflicting vital monetary and logistical challenges, stated Erin Ercoline, govt director of the San Antonio-based ThriveWell Most cancers Basis. The nonprofit offers grownup sufferers with monetary help, together with for gaps in insurance coverage and transportation-related prices. It has helped cowl gasoline for Sanchez, who obtained her last spherical of chemotherapy in late June. The monetary help will even pay for her lodge when she travels for breast surgical procedure in August.

Not all rural hospitals are ending chemotherapy. Childress Regional Medical Middle, a 39-bed hospital in West Texas, is developing a 6,000-square-foot heart for sufferers who want infusions for most cancers and different diagnoses, together with multiple sclerosis and rheumatology.

The infusion space, which began with two chairs in 2013 and now has 4, will develop to 10 chairs and have extra affected person privateness when it opens subsequent 12 months. The subsequent-nearest infusion heart on this sprawling area is an hour or extra away, which discourages some sufferers from in search of care, stated Childress’ CEO, Holly Holcomb.

“We have had a handful of sufferers say, ‘If you cannot do it right here, I am not doing it,'” Holcomb stated. She credit the federal 340B drug low cost program for enabling the distant hospital to supply infusion medicine.

Hospitals that qualify for 340B can purchase outpatient medicine at steep reductions. This system offers “an enormous kickstand for rural hospitals,” stated Topchik, of Chartis Middle. Hospitals can use the financial savings to buoy or develop companies supplied to the group, he stated.

However some sufferers will not be daunted by lengthy drives and journey prices.

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Fred Hardwicke, an oncologist, critiques medical notes with Dennis and Mary Ellen Woodward. Dennis has a kind of non-Hodgkin lymphoma.
Charlotte Huff for KFF Well being Information

“I am from the nation, so small is healthier — it is simply extra personable,” stated Dennis Woodward, 69, who lives in Woodson, Texas. He has a kind of non-Hodgkin lymphoma and chooses to make a two-hour drive to Childress. He had first visited an oncology clinic in Abilene about an hour away. The clinicians have been good, however “I felt like a quantity,” he stated.

After his first appointment at Childress this 12 months, his oncologist, Fred Hardwicke, walked him over to fulfill the nurses who would administer the medication, Woodward recalled.

Most Fridays throughout Herlinda Sanchez’s chemotherapy, Manuel would nap within the automobile. However throughout her last therapy in June, he stayed close by, counting down the hours.

A number of members of the family joined Herlinda when she rang the bell later that afternoon to sign the top of her therapy.

“I do not need to be in San Antonio no extra,” stated Herlinda, a mom of 4 who does administrative work at Laughlin Air Drive Base close to Del Rio. “I am trying ahead to the break.”

KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working applications at KFF — the impartial supply for well being coverage analysis, polling, and journalism.

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