To keep the doors open, financially strapped facilities in small communities nationwide continue to shed basic health care services, like obstetrics and chemotherapy, said Michael Topchik, executive director of the Chartis Center for Rural Health.
" The data are staggering," Topchik said. " Can you imagine feeling that sick, and having to drive an hour in each direction, or maybe more each direction, several times a week?"
Loss of chemotherapy services can signal other gaps in cancer care, such as a shortage of local specialty physicians and nurses, which is bad news for patients, said Marquita Lewis‐Thames, an assistant professor at Northwestern University in Chicago whose research covers rural cancer care.
Rural patients are less likely to survive at least five years after a cancer diagnosis compared with their urban counterparts, concluded a study co‐authored by Lewis‐Thames and published in JAMA Network Open in 2022. While the rural‐urban survival gap narrowed over the nearly 40 years researchers studied, the disparity persisted across most racial and ethnic groups, with only a few exceptions, she said.
Many cancer drugs are now given orally and can be taken at home, but some treatments for breast, colon and other common cancers must still be administered intravenously inside a medical facility. Even distances of an hour or two each way can strain patients who already may be coping with nausea, diarrhea, and other side effects, physicians and patient advocates said.
" It ' s pretty uncomfortable for some of these patients who may have bone metastases or have significant muscular pain and have to sit in the car that long and hit road bumps," said Shivum Agarwal, a family physician who practices in rural communities an hour west of Fort Worth, Texas.
Plus, travel can cost much more than filling the gas tank.
" Usually it requires an able‐bodied family member taking off a whole day or at least half a day from work," Agarwal said. " So, there ' s a big economic cost for the family."
In this sense, the Sanchez family is fortunate. Herlinda ' s mother drives four hours from Abilene to Del Rio to watch the couple ' s youngest children, their 2‐year‐old twins.