Freestanding Cancer Treatment Clinics: A Vital Link in the Healthcare Chain

Imagine you’ve just received the news that you have cancer, one of the most feared diseases in the U.S. Your doctor is talking about immediate surgery and months of treatment. A million thoughts start running through your head, including the question of how you will cope. What about your job, your family, your responsibilities, your life? You’ve heard stories about how rough cancer treatment is. What if you become too debilitated to take care of yourself? Then the doctor drops another bombshell on you: Your local medical facilities do not offer the treatment you need. The nearest cancer treatment center is 76 miles away, and you’ll need to get there and back every day for weeks.

Freestanding Clinics are Threatened

Freestanding Cancer Center

Those who live in urban areas rarely give any thought to the location of medical facilities, as many have not just one but multiple excellent facilities nearby. But for those who live in rural areas, geography can be a major obstacle to getting the healthcare treatments that they need.

Over the past decade, for example, many freestanding radiation therapy centers, especially those in rural areas that may only serve a dozen or so patients a day, have been forced to close their doors. Many have not survived a government-imposed 20% cut in pay, as the CMS (Centers for Medicare & Medicaid Services) has shifted reimbursement rates to significantly favor hospital-based radiation therapy services. This cut in reimbursements, coupled with the ongoing consolidation of healthcare networks nationwide, has threatened the on-going viability of smaller, regional cancer centers.

Unfortunately, many decision makers do not seem to understand why it’s so important for the system to support these freestanding cancer treatment clinics. Their view seems to be that since patients can be treated at hospital-based facilities there isn’t a problem. But the vital role that freestanding cancer treatment clinics play becomes obvious when it’s your own family member who needs cancer treatment.

“Independent freestanding oncology clinics (particularly those in smaller town where ironically they are most needed) are rapidly becoming an endangered species,” states Dr. David Jones, Medical Director/Radiation Oncologist at The Centers for Cancer Care. “Sadly, the affected community doesn’t realize what they’ve lost until it strikes home in their own family with exhausting drives to distant facilities day after day for a course of therapy that could have been safely delivered in their own backyard.”

Freestanding Clinics Improve Access to Care

Varian 21EX Linear Accelerator

For most cancers, radiation therapy is often done five times a week for three to seven weeks. The ability to receive this near-daily treatment at a facility close to home can make a huge difference for the patient and his or her family.

Travelling to a distant location is extremely grueling for patients who are already weak and ill from treatment or from the cancer itself. With radiation therapy, some may spend two to four hours on the road each day for a treatment session that takes less than 20 minutes. If the patient is still well enough to work, much of the work day is missed. If the patient is too ill to work, disability checks may not start arriving for months. In this case, the financial hardship extends to other members of the family as well, as they may need to take time off from work to get the weak and exhausted patient back and forth to the treatment facility. Some may even lose their jobs in the process.

One Family’s Story

“About two years ago my 55-year-old father began losing weight, a symptom which he ignored,” says Michael Teague, Director of Radiation Oncology at Radiology Oncology Systems. “Then in December 2013, after he became sick with pneumonia and started having headaches, a visit to urgent care revealed a large mass on his lung that was later confirmed to be Stage 3-A lung cancer.

Sentara Obici Hospital, Suffolk, VA, USA

“When my father began a four-week course of five-times-a-week radiation plus chemotherapy, he was still in relatively decent shape,” explains Teague. “This was a good thing, since there was no local freestanding cancer clinic located in the town in Virginia where he lived. On the days when the family’s single car was available, my father was able to drive himself back and forth to treatment 45 minutes away. Other days it was up to my mother, who was in and out of the hospital with complications of her diabetes, or sister, who lived nearby, to take time off from work to take him there. This was a process that took close to two hours altogether.

“That first round of treatment appeared successful,” Teague states. “The tumor shrunk from the size of a baseball to 4/5ths of that. My family’s morale was high, in spite of the financial toll that treatment was taking.”

“Unfortunately, things then took a turn for the worse in April 2014,” Teague continues, “when we learned that the cancer had spread to his brain.” The prescribed treatment was total brain radiation, once again at the facility that’s 45 minutes away. “By the end of June my father could barely walk, speak or eat. With his condition deteriorating, getting back and forth to Suffolk was now a three-hour ordeal for which someone in the family had to miss work each day. The physical, emotional and financial toll that this was taking on my family was enormous.”

“By July it became obvious that I really needed to be in Virginia to help out, as Dad was attempting a third round of palliative radiation care on the brain in efforts to ease the pain,” Teague says. “In less than two weeks my wife and I sold our home in Southern California, packed up, and moved East with our infant daughter. But the Monday we arrived was the last day that my father got up on his own. By that Friday we made the decision to begin hospice care, and he passed away the next day.”

What Can Be Done to Support Freestanding Cancer Treatment Clinics

Keeping afloat the smaller, regional cancer centers that improve access to care for people who live in less populated areas requires money. Reimbursement rates must be kept high enough to enable these clinics to stay open and offer a full range of services to their patients. The CMS’ recent decision to reject the radiation oncology reimbursement cuts that had been proposed for 2015 is an excellent step in this direction. And the CMS’ November 2014 proposal for Medicare to start paying for lung cancer screening (specifically, low-dose CT scans) for those who are at high risk of the world’s number one cancer killer is another excellent step in the right direction.

Reimbursement rates, however, are only half of the money equation. Costs are the other. Radiology Oncology Systems, for example, helps support these clinics by providing refurbished linear accelerators at less than half the cost of the new machines that are purchased by the large hospitals that can afford to make frequent upgrades. This refurbished equipment enables the clinics to keep their operating costs low while improving patient care with newer technology.

“My father was treated with external beam radiation on a linear accelerator,” states Teague. “Coincidentally, our company purchased that very machine from the hospital a few months later after it was decommissioned. Some of its components will be used to upgrade the equipment and technology at other facilities which cannot afford to purchase new machines. For example, one component is going to a small, rural cancer center. Radiology Oncology Systems is often able to improve the technology at freestanding clinics in this way, doing smaller upgrades versus replacing entire machines. This is an extremely cost-effective way for the clinics to increase the quality of care for their patients.”

Making It Personal

As Teague found, the need for freestanding cancer treatment centers becomes especially obvious when it’s you or a loved one who needs care. “I’ve been in the cancer-fighting equipment field for 10 years,” Teague notes, “and been involved in dozens of radiation oncology expansion and equipment upgrade projects. But even working at an organization that is committed to the belief that every cancer patient in the world should have access to quality radiation therapy for their treatment and care, I don’t think the impact of so many clinics going away really hit me until the issue became personal.

“Seeing the toll that travelling back and forth to the treatment center took on my Dad and family – both physically and financially – made me even more committed to doing what I can to help keep the nation’s remaining freestanding cancer treatment centers afloat.”

Michael Teague is the Director of Radiation Oncology Equipment at the San Diego-based firm, Radiology Oncology Systems.

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