Cancer patients in rural Maine now drive even further for treatment

Service deferrals at a Penobscot County cancer care center mean cancer patients in Washington County have to drive even further for treatment, or delay it.

Almost all cancer patients in Washington County receive treatment at the Lafayette Family Cancer Institute in Brewer, says East Machias family nurse practitioner Christine Moulton, but three months ago Lafayette stopped accepting most new patients.

“Now we have no idea where they will receive treatment, but wherever it is, patients will have to travel 6 to 12 hours round trip,” Moulton said. “This not only represents a crisis for residents of Washington County, but for all residents of Maine north of Waterville.”

Moulton first learned of the postponements in late August after several of his patients received preliminary diagnoses of cancer.

“These patients weren’t ready for referral to Brewer because they were still getting tests for the final diagnosis, but I knew they would end up there,” Moulton said.

Lafayette, a department of Northern Light Health, cites nationwide oncology staffing shortages and an increase in new cancer cases as the cause of the postponement decision. The rise in new cancer patients is partly because many people delayed cancer screenings during the pandemic, says Northern Light communications specialist Kris Currier.

“To ensure that our current patients receive the level of care they expect and deserve, Northern Light Cancer Care has made the difficult decision to temporarily defer some new medical oncology patient referrals,” Currier said. “This temporary adjustment ensures that we are able to safely meet the needs of our current patients.”

Getting to appointments in other counties can be difficult, if not impossible, for those who don’t have a vehicle, don’t have a driver’s license, or are too ill to travel for hours without being accompanied.

Under certain conditions, Lafayette is still accepting new patients, including referrals for returning patients, staff who are diagnosed, patients diagnosed by Northern Light oncologists while in hospital, people who require simultaneous chemotherapy and radiotherapy treatments and Northern Light patients. practices.

Everyone else is referred to one of four central and central Maine cancer care centers, which means traveling long distances that add hardship to the disease, Moulton says.

“You can imagine it’s bad enough traveling two hours to Brewer, but it’s manageable,” Moulton said. “But now you have to go to Rockland or Waterville or Augusta or Brunswick.”

Former cancer patient Holly Whitney of Marshfield received treatment in Lafayette, about 85 miles away, and said even getting to a clinic as close, relatively speaking, as Brewer was difficult during chemotherapy.

“You get nauseous and then you have to travel on bumpy roads,” Whitney said. “That’s too much for most patients.”

A rural struggle

Even before the postponements, cancer patients in Washington County were working hard to receive care, says Angela Fochesato, executive director of the Beth C. Wright Cancer Resource Center, which serves Washington and Hancock counties.

“We don’t have a lot of resources here, so patients with chronic conditions, in general, don’t get services. People in Washington County don’t have the same comforts as people in other Maine counties,” said Fochesato, who previously worked as a cancer navigator at Healthy Acadia. “Northern Light is doing what it can with what it has. There’s a silver lining to COVID – now we know we have a lot of fractures in our medical system.

Cancer is the second leading cause of death nationally (behind heart disease), but the leading cause of death in Maine, which ranks eighth nationally, and first in New England for the highest cancer rate. Of Maine’s 16 counties, Washington County has the third highest incidence of all cancers, at 520.4 cases per 100,000 population behind Piscataquis (539.9) and Penobscot (524.7) counties. , for the years 2015-2019, most recent data available.

Even so, according to a 2017 transportation needs assessment conducted by the Maine Cancer Foundation (MCF), most Washington County residents are more than 80 miles from a radiation center.

“A lack of oncologists in rural parts of the state, particularly in Washington County and southern Aroostook County, is resulting in excessive travel distances,” it read. the MCF assessment. “These areas would benefit most from having access to nearby oncologists.”

Solutions

There are no oncologists working in Washington County. To improve access to oncologists efficiently and quickly, Moulton says hospitals should expand their use of telemedicine. Not all aspects of cancer care can be managed remotely, but visiting the oncologist could be, she says.

“By the time the patient arrives at the oncologist, he has had blood tests, CT scans, MRIs, he has had a biopsy, a tissue sample, a pathology report, and he has a stage and a name” , Moulton said. “The physical exam that the oncologist does in that first encounter doesn’t add a lot of additional information to the treatment plan – you can do that through telemedicine. We don’t need a local oncologist, we just need good television.

What telemedicine can’t create is access to chemotherapy infusion appointments, notes Moulton, a cancer care service also not available in Washington County.

But one bright spot from Machias is making life easier for cancer patients – Moulton, Fochesato and Whitney all rent the Down East Community Hospital’s infusion clinic, where patients can receive supportive chemotherapy drugs and others services, much closer to home.

“I had a standing order to get fluids there, and it saved my life. I went from feeling terrible to feeling like I could function,” Whitney said. praise to the nurses at the infusion clinic. They took good care of me.”

Could the infusion clinic at Machias Hospital be expanded to also include chemotherapy services? It’s not out of the question, says DECH director of marketing and communications Julie Hixson, but it’s not close either.

“Over the years we have looked for ways to bring chemotherapy to the hospital and we continue to do so. So far it hasn’t been viable, but that doesn’t mean we’re going to give up,” Hixson said. “It doesn’t look like we’ll be able to bring chemotherapy to Washington County in the immediate future, but we will continue to increase therapeutics in our infusion clinic to reduce the number of long drives.”

Getting There

In the absence of local services, Washington County patients must travel to other counties. Getting there can be difficult, if not impossible, for those who don’t have a vehicle, don’t have a driver’s license, or are too ill to travel for hours unaccompanied.

“Transportation is a huge, huge problem,” Fochesato said.

Some government services pay for transportation to and from appointments, such as ModivCare, available to MaineCare clients, but program limitations mean patients can’t make other important stops, like at the pharmacy, on the way return. That’s where agencies like Beth C. Wright, Downeast Community Partners and Ellsworth-based Friends in Action are trying to fill the void, often with financial support from the nonprofit Maine Cancer Foundation.

“Our Downeast partnerships have had a tremendous impact,” said MCF Executive Director Ray Ruby, noting that MCF shifted its focus from research to programs in 2015. “Over the past seven years, we have invested $2.1 million in Hancock and Washington counties for transportation, as well as other major areas of need.

Fochesato would like to see more federal funds dedicated to patient service programs like transportation, palliative care and home health services.

“We need to go to Washington and tell them to change their funding model, to start funding cancer and not just public health,” Fochesato says. “Because cancer is an epidemic. And it’s been years; everyone lives with now.

Federal funds earmarked for cancer research are critically important, she says, but until there is a cure, there must also be patient services.

“Because once cancer patients hear this diagnosis, they don’t hear anything else,” Fochesato said. “We need to meet patients where they are and walk them through the journey so they can go from survivors to thriving.”

This story first appeared in Machias Valley News Watcher and has been republished with permission.

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