Is it Possible to Have a Broad-Based Cancer Team in a Rural Area?

As a woman living with metastatic breast cancer since 2018, I recently listened with great interest to a podcast as part of the “Our MBC Life” series, about a health center for women with metastatic breast cancer in large city where the focus was providing on broad-based supportive care.

Women come in for a day-long evaluation session involving oncologists, counselors, physical therapists, nutritionists, social workers and others with a comprehensive treatment plan as the goal. It sounded wonderful.

Then I remembered I live in Wyoming, our 9th largest state but with the least population of any state in the U.S., with well under 600,000 people. This center was a long way away!

But on second thought, I realized that despite living in a rural area without the range of specialties and health care professions common in bigger cities, I have been able to pull together a remarkably comprehensive care team.

My primary medical oncologist, who specializes in breast cancer, is about 60 miles away in Colorado. I see her several times a year in person, but more often by telehealth which is a blessing. She has coordinated my care with our smallish cancer center in my hometown, so any injections, infusions, imaging, blood work and other monitoring is done locally through the cancer center and the hospital. The infusion nurses and pharmacist in the cancer center communicate and consult with her.

When needed, I get care from a radiation oncologist who travels to my hometown one day a week. The hospital rehabilitation center has a physical therapist who has a background in oncology and her experience with mobility and exercise needs in cancer has been invaluable. I have a local counselor who I found by asking for someone with a background in cancer care. I see her once or twice per month. The community pharmacy has been great to make certain I have the other medications I need.

I have also been able to take advantage of support services in Colorado where my oncologist is, getting help from their palliative care team, nutritionists and integrated care physician. I even have been able to see an acupuncturist with the help of the counselor.

It’s not perfect, although no system is. For example, the level of coordination like at the big center with everyone on site isn’t possible, but through the electronic health record there is communication and coordination across disciplines. I can track my appointments, treatment plan, lab workand scans through the patient portal.

To a certain extent, this happened by luck. I have an oncologist who is open to this model of care. Importantly, the local cancer center also embraced this model. The integration of health care systems across communities and settings has also helped. Consequently, the oncologist, the staff at our hospitaland I have been able to coordinate those services so that I can get care mostly at home

Setting up a care team can be challenging, and it is important to note, I am fully insured, and I have a background in health care as a nurse working within the system that I now get care. However, my experiences may help others with cancer, especially metastatic cancer, develop a health care team that provides the support they need in more isolated areas. But these are tips that I’ve found helped me to be successful:

• Ask and ask again. What is possible given the unique nature of your health care system? Your family situation? Your needs?
• Engage your friends, familyand others in the community, such as support groups. What resources do they know about in your area? What’s worked for others?
• Connect with a nurse patient navigator or social worker wherever you can. They can be a wealth of knowledge.
• Communicate, communicate, communicate. This is critical to do across settings, health care professions and the patient/family on an ongoing basis so that all know who is doing what.
• Use the patient portal, which is a great way to track all that is happening amongst sites and professionals.
• Take advantage of telehealth opportunities. The pandemic opened a lot of opportunities and use them!
• Finally, be flexible. It won’t be perfect, but it can be close. And not having to travel so much can be extremely beneficial to you and your family.

This post was written and submitted by Mary Evelyn Burman. The article reflects the views of Mary Evelyn Burman and not of CURE®. This is also not supposed to be intended as medical advice.

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