Years of effort by Montana State University’s nursing college and its partners have helped increase access to cancer care in rural Montana.
A breakthrough grant from the Merck Foundation has brought oncology services to Barrett Hospital and HealthCare in Dillon, a town in southwest Montana with around 4,000 residents. With a new infusion center that opened in October, scores of rural patients can receive care close to home instead of traveling over two hours to a hospital in Bozeman.
The $1.9 million grant, awarded in 2022 to Conquer Cancer, the American Society of Clinical Oncology (ASCO) Foundation, will run through June 2027. MSU, Barrett Hospital and HealthCare and Bozeman Health receive funds to support the implementation and evaluation of a shared-care model of cancer care delivery.
Traveling for treatment has a significant impact on cancer patients, especially in a state with harsh winter weather like Montana, said Marg Hammersla, a professor in the Mark and Robyn Jones College of Nursing who is helping with logistics and conducting the evaluation for the grant.
Data show that the farther patients need to travel, the more likely they are to forgo treatment, Hammersla said. Often, patients must stay overnight before or following treatment to ensure they aren’t impacted by road closures during winter storms, or they must purchase snow tires to make it to treatment safely.
But by adding cancer care to rural areas, “Our hope is that patients will actually have better outcomes, because the financial and physical burden of receiving treatment will be decreased,” Hammersla said.
The first two years of the grant were used to solve logistical details and train staff, Hammersla said. Bozeman Health trained a nurse and physician assistant in oncology care for Barrett Hospital and HealthCare, and staff securely transferred patient medical records. Then, the hospital funded the construction of an exam room, infusion suite and offices for the new staff.
Barrett’s new infusion suite opened on Oct. 1, 2024, to high demand from patients in the Dillon area. By the end of 2024, the hospital had recorded a total of 45 clinic visits and 30 treatment visits. That has already reduced patient travel by over 38,000 miles and saved people over $10,000 in fuel costs alone, Hammersla said.
Lyndee Fogel, director of pharmacy at Barrett Hospital and HealthCare, applauded the grant’s impact. Fogel has worked for the hospital for over 30 years and recalled talking about wanting to bring oncology services to Dillon in her job interview.
Fogel said past attempts did not succeed due to a lack of resources to train the required staff. But the Merck Foundation grant provided enough funding for training and programmatic support that enabled a doctor and physician assistant to practice in the clinic multiple days a week. Fogel also received oncology-specific pharmacist training in Bozeman, too, and said the partnership between the two healthcare providers was “invaluable.”
“This is something this community has needed for a long time, and I am just so thankful to be involved,” Fogel said. “I’m so happy that we are finally seeing it happen, and that we have a program that’s going to grow and get better for our patients and our community.”
Dillon residents Grace and Bill Salada are just two of the people the new infusion center is helping. Last October, Grace was diagnosed with Stage 4 breast cancer. Aside from experiencing abrupt weight loss, she had no idea she was sick.
The couple, high school sweethearts originally from Pennsylvania, called the diagnosis a “shock.”
“When they said that she had an incurable cancer, I told the doctor, ‘God, we’ve only been married 56 years,’” Bill Salada said. “He said that’s a long time. I said, ‘Yeah, but not long enough for me.’”
Had Grace needed to travel to Bozeman and stay overnight for weekly chemotherapy, she would have chosen to go without treatment. Instead, she can receive chemotherapy at a hospital three minutes from home. Still, the Saladas wish the doctors had caught her cancer earlier.
Their story is not uncommon for residents of rural areas like Dillon. Addressing the rural cancer care gap has long been a focus of hospitals, medical associations and research institutions like MSU.
Jack Hensold, a former oncologist at Bozeman Health and chair of the ASCO Rural Cancer Care Task Force, said that compared to cities, rural areas see less screening for cancers, with patients often diagnosed in the later stages. Rural patients also have limited access to clinical trials and potentially life-saving drugs that are in development.
“The problem when we say the outcomes are worse in rural areas – there’s more poverty in rural areas, there’s less health insurance coverage in rural areas, there’s limited access because of the geographic barrier to care,” said Hensold. “So the question is, is it any one of those things that are primarily responsible, or are they all working together?
“What we can do moving forward is say, if we believe access to be one of the problems, let’s improve access and then see if that improves outcomes,” Hensold said.
That’s why the MSU nursing college’s work on the grant has been invaluable, he said. Hammersla’s research expertise has helped quantify and report the impacts of the grant, and she has been an invaluable “boots on the ground” resource to help streamline communication among the collaborators.
By detailing the implementation strategies, costs, challenges and successes, the aim is to establish a framework so other hospitals, particularly in rural communities, can replicate the efforts, said Janette Merrill, the grant’s project lead and senior director of care innovation for ASCO. The lessons will be detailed in a journal publication, in meetings and on ASCO’s website.
Marg has brought her research expertise and formed the relationships to get the data that we need,” Merrill said. “She’s done a lot of mapping the systems and looking at process improvement, so we can take those lessons learned and disseminate that information. We truly couldn’t have done this without her.”
Though the Merck Foundation grant funding ends in 2027, the hospital and its partners are confident the infusion center will continue to operate into the future. Right now, the hospital has diverted patients from Bozeman, but there are conversations ongoing with other hospitals to transfer even more patient care to Barrett.
“It’s great that word is getting out this program is up and running, and patients are getting this care,” Merrill said. “It’s getting the attention of other funders and oncologists who have patients traveling to Utah or Wyoming. Now, there’s the opportunity to help anyone living in Dillon diagnosed with cancer who was going to have to travel for that care.”
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