Reaching rural areas with the best cancer care

By Mary Lemma

Twice a month for almost three years, Madeleine Kane, MD, has been catching a 6:30 a.m. flight from Centennial Airport near Denver to care for cancer patients at the San Luis Valley Regional Medical Center in Alamosa, about 220 miles southwest of the state capital. There she sees 15 to 20 patients, then dictates progress notes and writes chemotherapy orders before flying back to Denver almost ten hours later.

Kane, professor of medical oncology at the University of Colorado School of Medicine, staffs two full-day medical oncology clinics a week at the University of Colorado Hospital Anschutz Cancer Pavilion. Every Thursday, she sees oncology patients at the Denver VA Medical Center, and every other Monday she sees HIV/AIDS-related cancer patients at the Infectious Diseases Clinic at UCH. She also travels to San Juan Cancer Center in Montrose to see cancer patients every couple of months, which she has been doing for nine years.

Madeleine Kane, CU Cancer Center doctor

Madeleine Kane, MD, medical oncology and medical director of CU Cancer Center’s Clinical Investigations Shared Resource.

Since 1985, the CU Cancer Center has provided consultations and direct patient care at partner sites across Colorado. Today, those sites include hospitals in Grand Junction, Alamosa, Glenwood Springs, Montrose and Vail/Edwards. The center employs a full-time coordinator to help with patient referrals to the center’s main facility in Aurora for therapies those rural and mountain hospitals can’t provide.

For Kane, the rewards of rural outreach far outweigh a seemingly daunting schedule. “The most rewarding aspect of the work I do is probably the ability to educate patients and engage them in being part of a team in managing their cancer. This reduces their fear and anxiety,” she says.

Outreach to cancer patients in rural and mountain areas is critical because patients there don’t have easy access to cancer care compared with patients in urban and suburban areas. At the university, Kane focuses on head and neck, GI and thyroid cancers, but rural outreach entails treating the full spectrum of cancers and blood disorders.

Kane has been called “the optimistic oncologist,” but that is not to say she wears rose-colored glasses. “I try to offer hope but am realistic,” she says. “There are very few situations where the cancer isn’t treatable even if it’s not curable.”

Kane stresses there is more than one option for patients, and as the principal investigator on as many as 10 cancer clinical trials at a time, and co-investigator on 40 or more, she’s a big proponent of bringing clinical research to rural sites. She oversees the Cancer Center’s clinical trials program. “We think of our clinical trials as standard-of-care options, and we’re fortunate because the clinical research staff is very motivated and educated,” she says.

The San Luis Valley Regional Medical Center now can offer a level of care it was unable to provide as recently as 2008, when one oncology nurse did everything. Today the hospital has a dedicated cancer scheduler, a full-time patient navigator and an oncology clinic manager help patients connect with funding and support, which is vitally important in an area that is not well off, Kane explains.

A stronger support system enabled one of Kane’s patients, Maria Fernandez of Sanford (see profile on opposite page), to begin her chemotherapy in distant Salida, then complete it at the oncology infusion center in nearby Alamosa’s San Luis Valley Regional Medical Center.

Maria had been diagnosed with stage IV lymphoma, but “with lymphoma, that is not as bad a prognosis with the availability of newer drugs,” Kane says. Her patient underwent intense chemotherapy and has been in remission since November.
”I feel very privileged to go to outreach clinics and take the expertise of the CU Cancer Center to people in rural areas where this isn’t available,” Kane says. “People are gracious and grateful…it’s really very rewarding.”

To learn more about care outside Denver, visit regionalnetwork.coloradocancercenter.org.