What Happens When Rural U.S. Hospitals Shut Down?

Imagine this scene

Ellen, a 75-year-old cancer patient, has just been prescribed 30 days of radiation therapy. She lives in a town of 25,000 people. Each day, her son drives her to her local hospital, where she lays on the table of a linear accelerator and gets 10 minutes of radiation delivered to her tumor.

But one day, her local provider shuts down. Now Ellen has to drive three hours round-trip for her treatment. Her son works and can’t take three to four hours a day to drive his mother. What will Ellen do? Will she continue with her cancer treatments? Or will she just stay home and learn to live (or die) with her cancer?

Ellen is a hypothetical patient, but her dilemma is very real. DotMed recently reported that 30% of hospitals in rural America are at high or immediate risk of shutting down, mostly due to financial problems. In many of these regions, hospitals are not only the main source of primary and emergency care, but also the only place to receive specialized services like lab tests or imaging studies. Without access to dedicated cancer clinics, the patients served by these facilities may soon face hours-long drives to access treatment.

More than just an inconvenience.

A recent literature review in JCO Oncology Practice found that rural cancer patients have “lower rates of preventative screening, more advanced disease at presentation, and higher mortality rates” than their urban counterparts—and the authors identified transportation access as one of the biggest barriers to care for these patients. Older cancer patients may struggle the most, as they often rely on friends and family for transportation. Radiation therapy requires physical visits every day, and the shutting down of local, rural hospitals and cancer centers presents a huge risk to thousands of people like Ellen.

What can we do about it?

First, it’s necessary to understand why these facilities are shutting down. It all comes down to finances—and in most facilities, radiation equipment is one of the largest line items. For example, one new linear accelerator can cost anywhere between $1.5 million to more than $4 million.

Using slightly older, refurbished equipment is one solution for hospitals and cancer centers whose patient base cannot bear the cost of new equipment. By lowering the cost of equipment, and therefore the care, more centers can operate profitably with fewer patients. Although some facilities replace their equipment every 7 to 10 years, the truth is that refurbished equipment can provide high-quality treatment for much longer than that. (Some facilities in developing countries deliver effective patient care using equipment as old as 40 years.) Low-density rural areas are the perfect markets for these machines to finish their useful lives.

Our mission at Radiology Oncology Systems is to expand the reach of linear accelerators to rural areas through refurbishment and resale. If your facility has a used machine, purchasers like ROS can repurpose it and install it in a place of need. By seeking buyers who will refurbish machines rather than scrap them, facilities replacing their linacs can help improve treatment access for patients like Ellen, ensuring equitable access to cancer care nationwide.