Cancer patients struggle with long travel times to treatment

Seven years after a Maine Cancer Foundation study identified transportation as a major barrier to treatment for cancer patients in the state’s most rural areas, the same communities are still struggling with long travel times to treatments. 

Since 2017, Maine has lost several cancer treatment centers, including the closure of the oncology practice at St. Mary’s Regional Medical Center in Lewiston in July 2023. The state has just a handful of radiation treatment sites, mostly in southern Maine.

The number of practicing oncologists has stayed roughly steady, with 76 practicing in 2017 and around 71 in 2024, according to state licensing data, and services are still concentrated in the southern region.

Aroostook and Washington county patients must travel on average more than 100 miles for inpatient cancer care, and two of the counties with the highest rates of deaths from cancer — Washington and Somerset — are without a single oncology practice. 

“You’re fighting just to survive to get to your treatment,” said Angela Fochesato, the director of the Beth C. Wright Cancer Resource Center in Ellsworth.

Mainers are at a significantly higher risk of developing and dying from cancer than the national average, with rural residents most at risk, according to a recent report on cancer in Maine. 

While the rate of Mainers dying from cancer decreased over the past decade, from 170 deaths per 100,000 people in 2014 to 161 in 2024, according to the Centers for Disease Control and Prevention, rates are still higher than the national average and anywhere else in New England.

There are many factors, including obesity, alcohol, tobacco use and exposure to environmental hazards such as ultraviolet rays, radon and arsenic.

Longer travel times to care can delay early detection of the disease, which has been linked to a higher likelihood of death. 

Traditional treatment plans often require therapies like radiation once a day, several times per week.

For those farther from care locations, these barriers translate to hundreds of dollars in transportation costs and hours of driving. Patients who don’t have access to a vehicle, or those too sick to drive, face additional hardships.

That was the case for Kathleen Bell, who was diagnosed with stage three breast cancer in February 2013 after a mammogram screening following a skiing accident. 

Bell’s husband had passed away two years earlier. She was alone and without the finances to make various appointments in Bangor from her home in Lincoln, a roughly two-hour drive round trip. 

Bell underwent four rounds of chemotherapy every three weeks, lasting 5 1/2 hours each time, and received 36 radiation treatments by the end of the year. 

“My keys were always in the nightstand next to me,” said Bell. “But I was so sick, I knew I couldn’t even move.”

Friends from a local book club drove her for a while. Eventually she was connected with Penquis Transportation Services, an agency with an office in Bangor contracted with the state to provide rides for certain patients with insurance through MaineCare.

“I would not have survived without Penquis,” Bell said. “Without them I would have died.” 

Penquis, one of the primary transportation providers for MaineCare beneficiaries in northern and eastern Maine, made 672,339 trips last year, according to the Bangor Daily News.

More than half – around 350,000 — were part of Penquis’ Accessing Cancer Care program, according to figures provided by Steven Richard, the nonprofit’s director of transportation. 

Penquis spent more than $25 million on transportation services last year alone, roughly 33 percent of its $75 million annual budget. 

“Every pot of money that we manage to find, we’re able to spend pretty quickly,” said Richard. 

Many rides require specialized equipment because the organization works with patients who have mobility issues or require certain medical aids.

“Sometimes they need wheelchair accessibility, sometimes they need us to actually be able to secure additional bottles of oxygen if they’re on a high consumption rate for it,” said Richard. “So those are some of the concerns (we consider).”

The Maine Cancer Foundation provides a large portion of funding for such initiatives. The director of programming, Katelyn Michaud, said the requests for grants have not slowed in her 10 years there.

“We have been investing a significant portion of funds toward transportation for cancer patients,” said Michaud, adding that Mainers would benefit from a more cohesive, statewide approach, particularly for patients who need to leave the state for care. 

“It’s one thing to get a patient from Washington County to Brewer, but then it’s another to get a patient from Washington County to Portland, perhaps, or to Boston,” she said.