Christopher Smith for Kaiser Health News
On a Monday in February, 65-year-old Karen Endicott-Coyan grabbed the wheel of her black 2014 Ford Taurus with both hands as she completed the one-hour drive from her farm near Fort Scott, Kan., To Chanute.
In a rare form of multiple myeloma, she needs weekly chemotherapy to keep the cancer in check.
She made a painful journey, having left her morphine for the day to be safe. Since she sometimes "gets the puke" after the treatment, she was driven back by her neighbor and friend Shirley Palmer (76).
Continuity of care is crucial for cancer patients during treatment, which often requires repeated outpatient visits. By the time the Mercy Hospital Fort Scott, the rural hospital in Endicott-Coyan's hometown, closed its doors in late 2018, the hospital officials had made sure that its cancer clinic – the so-called "Unit of Hope" – remained open.  Then "I got the email on January 15th," said Reta Baker, the hospital's CEO. It told her that the Cancer Center of Kansas, the contractor who operated and occupied the unit, had decided to shut it down two weeks later.
"There are too many changes in this city" to keep the cancer center open Yoosaf "Abe" Abraham, Chief Operating Officer of the Cancer Center of Kansas, later said to KHN. He added that patients were "OK" because they could be treated in the center's offices in Chanute and Parsons.
Fort Scott is 50 and 63 miles away from Fort Scott.
For Endicott-Coyan and Dozens In other cancer patients, removal meant new challenges for a life-saving treatment. "They have a flat tire, and there's nothing out here," Endicott-Coyan said, waving his arm toward the open sky and pastures strewn with black angus and white-faced cattle on either side of Hereford's strapless narrow country road Now she has to drive to get to her chemotherapy appointment.
Nationwide, more than 100 rural hospitals have been closed since 2010. In any case, there is a clear but well-known loss.
The residents of course lose health services as the wards are closed and doctors and nurses move away.
The ripple effect can also be devastating. The economic vitality of a community is diminished without the hospital's high-paying jobs, and it is becoming more difficult for other industries to attract workers who want to live in a city with a hospital. What is left threatens to wither without the support of the stabilization institution.
Fort Scott's 7,800 residents are suffering from the loss of their 132-year-old community hospital, which Mercy closed in late December. a St. Louis based nonprofit health care system. The hospital, which was established on the border in the 19th century and converted into a modern 69-bed facility in 2002, had survived its use of mostly empty hospital beds, according to the parent company.
For the next year, Kaiser Health News and NPR will follow up on how its citizens are doing after closure, hoping to answer urgent national questions: Do citizens in small communities like Fort Scott need a traditional hospital for their health needs? If not a hospital, what then?
Traveling Distance to Cancer Treatment
Reta Baker, the hospital's CEO, grew up on a farm south of Fort Scott. She understood that the closure of the hospital was inevitable. She made every effort to ensure that basic health care needs were met.
Mercy agreed to keep the building open until 2021 and turn on the lights. And Baker recruited a state-qualified health center to take care of four ambulances, including one in the hospital; former employees were bought up and continue to operate a rehabilitation center; and the not-for-profit Ascension Via Christi Hospital in Pittsburg reopened the emergency room in February.
However, cancer treatment, which requires skilled workers and the purchase and storage of a range of oncology medicines, presents unique challenges in rural areas.
Cancer patients in rural areas usually spend 66% more time on their journey to treatment than in urban areas. This is the conclusion of a recent national survey by ASCO, the American Society of Kansas, on Clinical Oncology. Dr. Monica Bertagnolli, a daughter of the livestock breeder, who is now chair of the ASCO board, described this as an "enormous burden". Cancer treatment, she explained, is "not just a visit and you're done."
Based on federal data, ASCO found that about 19% of Americans live in rural areas, with only 7% of oncologists practicing there.  According to a 2017 report from the Centers for Disease Control and Prevention, people in rural America are more likely to die from cancer than in the country's metropolitan areas. In rural areas, 180 deaths per 100,000 people per year were recorded, compared with 158 deaths per 100,000 people in populous metropolitan areas.
The discrepancy is partly due to rural residents smoking more frequently, but the risk of death goes beyond that, said Jane Henley, CDC epidemiologist and lead author of the report. "We know that geography can affect your risk factors, but we do not expect it to affect mortality."
From an office in a former Mercy ambulance, Fort Scott's cancer support group, Care to Share, continues to address some of the needs of the community – which have in some ways increased since the onset of hope. It offers cancer patients nutritional supplements, gas vouchers and emotional support.
Lavetta Simmons, one of the self-help group's founders, said she needed to raise more money to help people pay for gasoline so they could go on to treatment. Last year, Care to Share spent more than $ 17,000 in this impoverished corner of southeastern Kansas to provide gasoline money to local residents who needed to drive to or from Mercy Hospital.
The group expects to spend more on gasoline after Simmons spent nearly $ 6,000 in the first four months of 2019.
And the reserves of donated Ensure from Mercy are running low.
With Mercy Hospital Fort Scott Concluded, the likelihood that residents will die of cancer here will increase, experts fear, as access to specialists and treatment is so much more difficult.
Krista Postai, who took over the four clinics at Fort Scott Hospital, said that this was not unusual for her staff to "see someone in [with] end-stage cancer walk" whom they deposed because of her No money, no insurance or just as you are … We wait too long here. "
" If they can not heal me, I'm done "
Art Terry, 71, a farmer and Vietnam veteran, was one of them.The doctors discovered Terry's cancer after he died when they found a mass under his armpit, it was already late-stage breast cancer that had metastasized into his bones.
With his twice weekly chemotherapy in the Unit of Hope, Terry spent hours with his son and grandchildren, telling stories and jokes as if they were in their own living room. The nurses felt like a family, and Terry brought them fresh eggs from his farm.
"Dad could not have had better or more personalized care anywhere," his son Dwight said, eyes dull, after a shift at the factory. 19659008] Terry knew it was difficult to find a reliable cancer treatment. The shortage of cancer specialists in southeastern Kansas meant that many, including patients at Mercy Hospital Fort Scott, visited oncologists once or twice a week to visit their communities. [Wichita-basedCancerCenterinKansashasnearlytwodozenlocationsacrossthestate
It began in the mid-2000s with the lease of space in Fort Scott's hospital basement, Abraham said. The hospital provided the staff, while the Cancer Center in Kansas sent rent-paying and traveling oncologists to treat patients.
When it was closed, the Unit of Hope supplied nearly 200 patients, of whom about 40% received chemotherapy.
When Art Terry was diagnosed, his son Dwight tried to talk to him about whether he should be treated in the larger hospitals and academic centers in Joplin, Missouri, or in the Kansas City area. The older Terry was not interested. "He's like & # 39; nee & # 39 ;," Dwight Terry recalled. "I drive straight to Fort Scott, if I can not heal, I'm done, I'm not driving."
As the older Terry struggled to stay alive, Dwight said he had his father drove the hour to Chanute for treatment. Gasoline – already an increasing cost burden as they drove the 32 kilometers from the farm near the tiny Prescott in Canada to Fort Scott – would be even more expensive. And the journey would be a burden to his father, who had traveled so little during his lifetime that he had visited Kansas City only twice in the last 25 years.
As it turned out, the family never had to make a choice. Art Terry's cancer entered his brain and killed him days before the hospital's cancer department closed.
When Endicott-Coyan and her friend Palmer went to Chanute for treatment, they had the time to chat about how the closure of the hospital changed Fort Scott. "People started selling their homes," Palmer said.
Like many at Fort Scott, they both spent their days at Fort Scott Hospital. Endicott-Coyan has been in administration for more than 23 years. Palmer volunteered for six years at the aid organization.
The hospital grew with the community. But as the fate of the city diminished, it was perhaps no surprise that the hospital could not survive. But the intertwined story of Mercy and Fort Scott is also why his loss hit so many people so hard.
Fort Scott began in 1842, when the US government built a military fort to help with the nation's expansion westward. Historians say Fort Scott was a boomtown in the years just after the Civil War. The population increased to over 10,000, as the city was in competition with Kansas City for the largest railway center west of the Mississippi.
The hospital was a hospital integral part of the community after the Sisters of Mercy opened a 10-bed hospital in 1886 to help the needy and poor. Baker, president of Mercy Hospital Fort Scott, said the cancer center was an extension of this mission.
Hope's unity began operating out of the basement of the newest hospital building, which was "pretty tight," Baker said. As cancer treatments improved, it grew so fast that Mercy executives moved them to a spacious first-floor space that formerly housed business premises.
The center, with its subdued natural grays and browns, had windows facing the front lot and the woodland beyond. Each patient could look out of the windows or watch a personal television terminal. Each treatment chair had enough room for family members to pull up chairs.
When Endicott-Coyan and Palmer arrived at the Cancer Center of the Kansas Clinic in Chanute in February, things looked very different. The patients entered a small room through a rusted back door. On either side of the front door were three brown infusion chairs, and two television monitors mounted high on the walls.
A nurse checked Endicott-Coyan's blood pressure and led her back to a private room for a shot in the stomach. About 15 minutes later she was able to drive off.
Abraham of the Center said the Chanute facility was "initially good for patients" and not a "Taj Mahal" like Mercy's Fort Scott hospital building, which he considered too expensive. The Cancer Center of Kansas is planning to open a clinic in a hospital in Girard, about 30 miles from Fort Scott.
Some oncologists would say that driving a car is not necessary. In fact, some health care systems across the country, such as Sanford Health, South Dakota and the hospitals of Thomas Jefferson University, Pennsylvania, have chemotherapy in patients at home. Oncologist Adam Binder, who practices with Thomas Jefferson in Philadelphia, said, "Over 50% of chemotherapy would be safe in the home environment if the right infrastructure were available."
But the infrastructure – these are the nurses who would travel The treatment of patients and a reimbursement model for such treatment within our complex healthcare system are not yet in effect.
Back in the car, Palmer took control and Endicott-Coyan began planning for future cancer treatment in emptying Mercy Hospital leaving Fort Scott's closure. "Today I posted a message on Facebook and said," OK, I have drivers for the rest of February. I need drivers for march! "
Kaiser Health News is a non-profit health news service. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.