美国国家公共电台 NPR Have Cancer, Must Travel: Patients Left In Lurch After Town's Hospital Closes（在线收听）

SARAH MCCAMMON, HOST:

People are more likely to die from cancer in rural America than in more metropolitan areas of the country. The reasons range from higher rates of smoking to a lack of places to get tests and treatment. The historic small town of Fort Scott, Kan., lost its busy cancer treatment center when the hospital closed there. Reporter Sarah Jane Tribble went to Fort Scott to see how patients are coping.

SARAH JANE TRIBBLE, BYLINE: Karen Endicott-Coyan is 65 years old. She was diagnosed with a rare form of multiple myeloma four years ago. Her weekly chemotherapy treatments used to be at the Fort Scott hospital 15 minutes from home. She would run errands in the morning, stop by the hospital for her shot and then drive herself home before the fatigue and nausea hit. Now, though, it's a trip to another town for treatment.

KAREN ENDICOTT-COYAN: Yup - right here - not the first stoplight or a stop sign but the second one.

TRIBBLE: So I join her and her driver, sister-in-law Debbie Coyan (ph), on a weekly trip. At this new place, cancer patients go in the back door.

ENDICOTT-COYAN: I told somebody, it just feels like we just go in right by the trash. It isn't very welcoming.

TRIBBLE: The cancer center is an hour-long drive from Karen's farm. In between, we pass pastures, cows grazing and fields of crops. The two-lane highways are narrow and uneven. And when a big truck carrying livestock barrels towards us in the opposite lane, the Chevy Equinox we're in shakes as it passes. But the drive is actually the least of Karen's worries as she walks up to the nurses. Cancer care is complicated.

UNIDENTIFIED PERSON: Hello.

ENDICOTT-COYAN: Hi. How are we ladies?

UNIDENTIFIED PERSON: Wonderful - how are you?

ENDICOTT-COYAN: We're good. Well, I say we're good. I went to the emergency room Tuesday.

UNIDENTIFIED PERSON: Oh.

ENDICOTT-COYAN: I was dehydrated. I had the pukes.

UNIDENTIFIED PERSON: Oh. Did they give you fluids?

ENDICOTT-COYAN: They gave me - well, yeah. I went to the doctor first. But over there, they don't have any way to give you fluids at the doctor's office now.

TRIBBLE: She's lucky. Friends and relatives take turns driving with her for the typically two-hour round trip every Monday. And they patiently wait on days it takes longer, like today. Karen's lab results weren't ready. So instead, we get back in the car and drive to another hospital building for lab work. This hassle to get care is hard on cancer patients, says Joe Unger, a cancer researcher who led a study last year.

JOE UNGER: Not only are they suffering the anxiety of their diagnosis, they're then suffering the anxiety of how do they get their care and how do they travel to get it.

TRIBBLE: Unger's study confirmed that the work rural cancer patients like Karen had to do to find and get care is a major reason they die more often. Rural hospital closures, he says, don't help patients.

UNGER: You know, the issue of travel also creates income disparities in terms of access to care because those with more income are going to be more likely to travel to get their care more readily. And so these issues of income disparity and geographic disparities start to overlap.

TRIBBLE: Krista Postai has seen this firsthand in southeastern Kansas. She leads a group of health clinics in the low-income region.

KRISTA POSTAI: It's not unusual for us to see someone walk in end-stage cancer that they put off because they didn't have money. They didn't have insurance, or it's just the way you are. We wait too long here.

TRIBBLE: For now, Karen is coping. After her sister-in-law ferries her from the treatment center to the lab and back, we wait for the lab test to be processed. And then Karen gets her chemo shot. Now, we are back on the road. And Karen is prepared.

ENDICOTT-COYAN: And I have found that if I eat a few Ritz crackers or crackers on the way home, I don't get as nauseated.

TRIBBLE: For the next hour, she quietly munches, swallows hard and doesn't get sick. I'm Sarah Jane Tribble near Fort Scott, Kan.

MCCAMMON: And Sarah Jane Tribble is with Kaiser Health News.