\n\tCharlotte Huff<\/span><\/p>\n

The night before her chemotherapy, Herlinda Sanchez sets out her clothes and checks that she has everything she needs: a blanket, medications, an iPad and chargers, a small Bible and rosary, fuzzy socks, and snacks for the road.<\/p>\n

After the 36-year-old was diagnosed with stage 3 breast cancer in December, she learned that there weren\u2019t any cancer services in her community of Del Rio, a town of 35,000 near the Texas-Mexico border.<\/p>\n

To get treatment, she and her husband, Manuel, must drive nearly three hours east to San Antonio. So they set an alarm for 4 a.m., which allows for just enough time to roll out of bed, brush their teeth, and begin the long drive navigating dark roads while watching for deer.<\/p>\n

About an hour before they arrive at the cancer clinic, the couple pulls over to quickly eat fast food in the car. The break gives Herlinda time to apply ointment on the port where the needle for her chemotherapy will be inserted.<\/p>\n

\u201cIt numbs the area, so when I get to the infusion room the needle won\u2019t hurt,\u201d she said.<\/p>\n

For rural patients, getting cancer treatment close to home has always been difficult. But in recent years, chemotherapy deserts have expanded across the United States, with 382 rural hospitals halting services<\/a> from 2014 to 2022, according to a report published this year by Chartis, a health analytics and consulting firm.<\/p>\n

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Texas led that list, with 57 rural hospitals \u2014 nearly half of those statewide that had offered chemotherapy \u2014 cutting the service by 2022, according to the analysis. Rural hospitals in states like Texas, which hasn\u2019t expanded Medicaid<\/a>, have been more likely to close, according to data from the Cecil G. Sheps Center for Health Services Research.<\/p>\n

To keep the doors open, financially strapped facilities<\/a> in small communities nationwide continue to shed basic health care services, like obstetrics and chemotherapy, said Michael Topchik, executive director of the Chartis Center for Rural Health.<\/p>\n

\u201cThe data are staggering,\u201d Topchik said. \u201cCan you imagine feeling that sick, and having to drive an hour in each direction, or maybe more each direction, several times a week?\u201d<\/p>\n

Loss of chemotherapy services can signal other gaps in cancer care, such as a shortage of local specialty physicians and nurses, which is bad news for patients, said Marquita Lewis-Thames, an assistant professor at Northwestern University in Chicago whose research covers rural cancer care.<\/p>\n

Rural patients are less likely to survive at least five years after a cancer diagnosis compared with their urban counterparts, concluded a study co-authored by Lewis-Thames<\/a> and published in JAMA Network Open in 2022. While the rural-urban survival gap narrowed over the nearly 40 years researchers studied, the disparity persisted across most racial and ethnic groups, with only a few exceptions, she said.<\/p>\n

Many cancer drugs are now given orally and can be taken at home, but some treatments for breast, colon, and other common cancers must still be administered intravenously inside a medical facility. Even distances of an hour or two each way can strain patients who already may be coping with nausea, diarrhea, and other side effects, physicians and patient advocates said.<\/p>\n

\u201cIt\u2019s pretty uncomfortable for some of these patients who may have bone metastases or have significant muscular pain and have to sit in the car that long and hit road bumps,\u201d said Shivum Agarwal, a family physician who practices in rural communities an hour west of Fort Worth, Texas.<\/p>\n

Plus, travel can cost much more than filling the gas tank.<\/p>\n

\u201cUsually it requires an able-bodied family member taking off a whole day or at least half a day from work,\u201d Agarwal said. \u201cSo, there\u2019s a big economic cost for the family.\u201d<\/p>\n