Host
Heather Simonsen, MA
Public Affairs Senior Manager
Huntsman Cancer Institute
Lynette Phillips
Manager of Community Cancer Screening for Huntsman Cancer Institute
Tracy Onega, PhD
Senior Director of Population Sciences at Huntsman Cancer Institute
Professor in the Department of Population Sciences at the University of Utah
Heather Peterson
Participant at joint screening event between Huntsman Cancer Institute and Nevada Health Centers
Lucia Benitez
Participant at joint screening event between Huntsman Cancer Institute and Nevada Health Centers
Episode Transcript
Topics by Timestamp
- Expanding Access: Huntsman Cancer Institute's New Mobile Screening Clinic (00:14)
- Innovations in Breast Cancer Screening: The Role of Digital Mammography (03:34)
- Patient Stories: Navigating Accessible Breast Cancer Screenings (06:37)
- Bridging the Gap: Telehealth's Impact on Rural Healthcare (12:54)
- Expert Insights: Care Fragmentation in rural healthcare (17:10)
- Dr. Onega’s Research Journey: Telehealth for Rural Cancer Patients (20:46)
Heather Simonsen: You're listening to delivering a cancer free frontier podcast to create and provide better treatments. Today, we can bring these discoveries and the science-based medicine to people in need around the state, region and the world. I feel like the future is very bright, and I can't even imagine what cancer care is going to look like over the next 50 years. To continue that journey to eradicate cancer from the face of the earth.
Heather Simonsen: Hello and welcome to delivering a cancer free frontier. I'm your host, Heather Simonsen, we're starting today's episode on the Utah, Nevada border, where two towns meet in the middle of the desert: West Wendover, Nevada and Wendover, Utah. You may have passed through here before if you've ever driven cross country on Interstate 80. Wendover sits just west of the famous Bonneville Salt Flats for drivers. It's a welcome sigh of relief coming from east or west. There are no services, no towns, and very few people.
Expanding Access: Huntsman Cancer Institute's New Mobile Screening Clinic (00:14)
Lynette Phillips: In Wendover, there are casinos that are built right on that state line. They wanted to bring the gambling just as close as possible to Utah, but there are two casinos that straddle the state line, and we are at one of the two in their parking lot, literally staring at the casino.
Heather Simonsen: This is Lynette Phillips.
Lynette Phillips: I am the manager of community cancer screening for Huntsman Cancer Institute. That means I am the person who gets to work on a clinical side to increase cancer screening rates throughout the entire area that we serve. But today, specifically, we're focusing on our mobile mammography program.
Heather Simonsen: In fact, we're sitting inside the mobile mammography clinic, one of two now operated by Huntsman Cancer Institute.
Lynette Phillips: We call it our mobile clinic, or colloquially, we'll still call it the bus, basically a huge, large, gorgeous, custom motor coach, so we have a mammogram machine that performs screening mammography. One of the reasons, one of the barriers to care that a lot of people will run into is not having screening close to them or at a convenient location, especially some of our more underserved or rural communities.
Heather Simonsen: This kind of health care outreach is especially important for towns like Wendover. Together, the Utah and Nevada populations are just around 5500 many people here work in casinos or in hospitality more generally, West Wendover, Nevada has one public health clinic to serve the entire population, but the center doesn't offer mammography services. It's about a two hour drive to Salt Lake City and to Elko, Nevada, places that have more health care options, and that's where the mobile screening clinic plays an important role.
Lynette Phillips: It's all very warm inside and very comforting, and it's a clinic on wheels, and we take it to the patient. Instead of making the patient take a day off from work or drive hundreds of miles to get their mammogram, we bring it to them.
Innovations in Breast Cancer Screening: The Role of mobile screening (03:34)
Heather Simonsen: On today's episode of Delivering a Cancer-Free Frontier, we're discussing telehealth and mobile medicine just a few ways. Huntsman Cancer Institute is trying to improve access to cancer care across the vast mountain west. Huntsman Cancer Institute provides comprehensive cancer care to five large and vastly rural states, Idaho, Montana, Nevada, Utah and Wyoming. Many patients travel far distances to access health care, in particular, the kind of specialized care that's needed for cancer treatment. But as Lynette Phillips said, Huntsman Cancer Institute is finding new ways to bring care directly to patients where they are in their own communities.
When Huntsman Cancer Institute and the mobile screening team were in Wendover back in October of 2024 the screening clinic sat in the Montego Bay Resort and Casino parking lot. The music blasting from the casino entrance was loud. The generator powering the clinic was even louder, and our mobile mammography team had company.
Lynette Phillips: And we are about, I'd say, about maybe 30 feet away from the Nevada bus that's doing the same thing on the Nevada side of the state line.
Heather Simonsen: On this October day two, mobile cancer screening clinics lined up next to each other. A blue and white motor coach from Huntsman Cancer Institute and a bright pink semi tractor and trailer from Nevada health centers.
Lynette Phillips: For licensing purposes and liability purposes, we only screen on our mobile clinics inside of the state of Utah, but with Wendover being a border town, and part of it straddling the state line, our... one of our partners here at the Windover clinic thought it'd be really cool to have a Breast Cancer Awareness Month event where we brought the Nevada and the Utah mobile clinics together so we could screen all of the available women out here, instead of just part of them.
Heather Simonsen: Huntsman Cancer Institute's mobile screening bus has been in service since 2019,
So, it's five years old, and we have taken it everywhere, from the very south border of Utah out to Wendover. There's a place called Ibapah that we've taken it to, which is about an hour and a half south of Wendover, literally in the middle of the desert, and it's a small tribal community. We go all throughout Utah, just where the patients need us, especially where there's a lack of resources.
The mobile clinic has served an average of 1,465 patients per year and offers vouchers to uninsured women to make breast cancer screening more affordable. Lynette says the clinic travels to both rural and urban patients to offer 3D mammography as well as information on how to prevent other types of cancer.
Patient Stories: Navigating Accessible Breast Cancer Screenings (06:37)
Lynette Phillips: Utah, kind of is built along the freeway lines, so along I-15 in the northern part of Utah is what we call the Wasatch Front. Our beautiful mountains are the Wasatch Mountains, and about 75% of the Utah population lives in about a four or five county area surrounding Salt Lake. So that's where we spend the majority of our time. There is a lot of need, a lot of pockets of poverty and underserved people in that area, but we never want to forget our rural and frontier patients too. So, about a quarter of the time, we are out on the road, and we are trying to go find women where they need us the most, in their little, tiny towns and today in Wendover.
Heather Peterson: I'm Heather Peterson.
Lucia Benitez: My name is Lucia Benitez, and I'm 49. So, I'm a state certified community health care worker for the state of Utah, we connect people with resources and let them know what's going on. Help them fill out paperwork, help with translating. I knew that they were coming out here, so I decided to come and get my own mammogram done, just kind of to let the community know they're out here. They're you can trust the services and how convenient it is to have it out here. I live on the Nevada side of Windover, which is funny because it's literally three miles.
Heather Peterson: I do live in Wendover. When we first moved out here, I absolutely hated it, and I told my husband, you know what, I'm going to live with my parents, and you come visit when you can and then we thought, well, we'll stay here for two years. And then we decided that let's go. We've made it two years. Let's go five years and get retirement adding up. And then we made it five years. We're like, it's home. And if anything happens, the community will just pitch in. And it's so small that you know a lot more people, and you get to actually know the community. So that's, I think that's what grew on us.
Lucia Benitez: So, Wendover is small, everybody knows everyone. So, it could be a good or bad thing [chuckles]. You can get across town; you can go to work and leave your house within five minutes before you have to be at work. I moved here in 1995 I'm from California, so it was a huge change for me. I've never lived in such a small town, and I can. I liked it. I liked the fact that there was not a lot of crime. Everyone's friendly with each other, and again, there's no traffic. It's a nice place to live if you're healthy, but it's not the perfect place to live if you have the doctor's appointments all the time,
Heather Peterson: Being out in the middle of nowhere, it definitely has his challenges, and one of which is, there's no hospitals, no emergency room, you know, that kind of thing.
Lucia Benitez: It's very difficult. You have to take an entire day off, like, if you're working out, that's for the day off, so you're not getting paid. It's expensive. When you pay for gas, you pay for food, your time, and if you don't have anyone to take you, some of the people out here are actually paying $100 or more for someone to give them a ride in there. It's two hours to get in, plus whatever time you're at the clinic, and then two hours to get back. So, it's a whole day just to go in for one service.
Heather Peterson: I've just been really impressed with the mammograms. They, I mean, it's set up really well. The people are really, really nice and helpful. And knowing it was my first time, she totally walked me through it. And, you know, just hey, this is what to expect, and this is why. And so that was that was really nice. I was really nervous [chuckles], so it it kind of helped put me at ease that she was willing to take her time and explain things to me.
Lucia Benitez: You can come and get your mammogram done, that it's really convenient. You are just, it's you in the tech you can totally you can trust the people here. No one else is there. You're not going to be exposed. It's just as convenient as going into a clinic, if not better.
Heather Peterson: It makes it nice to have it out here, just so then we don't have to travel as far, and because the closest one is at least an hour and a half away, and I think that's why I've put it off, because it is so far. So the fact that they're willing to come out here and make it accessible for us, I think, is really important.
Lucia Benitez: You could do it during your lunch break, you can do it before you go into work, or you can do it when you get off of work, because you guys are here to like, two or three. So, it covers both shifts for casino workers. The casino is a 24-hour industry, so some people come in early. They're out by three. They're out by two by one. So, it works out great to have you guys out here.
Heather Peterson: Just the fact that they're willing to travel and come out to these rural places is it makes it really nice.
Lucia Benitez: But definitely get it done. It's not hard, it's not painful, and it's something everybody should, you know, every female should get done.
Heather Simonsen: In January 2025, Huntsman Cancer Institute unveiled its second mobile screening clinic. The new clinic has also been outfitted to provide colorectal cancer screening, skin cancer checks, self-collection for HPV testing and blood-based cancer screening, as well as mammography.
Mobile medicine isn't the only way Huntsman Cancer Institute is reaching out to rural patients or meeting them where they are. More and more physicians are interested in telehealth.
Tracy Onega: That is delivery of health-related care by some virtual means that can be, you know, audio based, but increasingly, you know, video based.
Bridging the Gap: Telehealth's Impact on Rural Healthcare (12:54)
Heather Simonsen: This is Tracy Onega. She is the senior director of population sciences at Huntsman Cancer Institute and professor in the Department of Population Sciences at the University of Utah.
Tracy Onega: That can be in real time, where you know you're on the other end of a screen, or a phone, a device with a healthcare provider, a healthcare professional. Or it can be what we call asynchronous you know, where you have maybe a mobile device that you know is monitoring your symptoms or your own health status, and that's feeding the data back to your healthcare team.
Heather Simonsen: For years, Dr. Onega has been particularly interested in how to expand healthcare access to rural patients as part of her role as a population scientist.
Tracy Onega: Population health is a useful concept, thinking about health for all of understanding patterns across the populations. Is there any difference for rural or urban individuals for some things? Yes, for some things, no, we wouldn't really know that unless we step back and look across the population, you know, and that's just one example, rural, urban, you know, other kinds of socio demographics. And even, you know, even in terms of cancer, where, where do we have the highest incidence for certain cancers. Do we have enough resources? Do we have to address that? Maybe we need to think more about prevention or screening in those areas, for those populations.
Heather Simonsen: I asked Dr. Onega why, as a researcher, she was so drawn to rural healthcare.
Tracy Onega: Most of my adult life, I've lived and my children grew up in really small rural town in Vermont, 800 people, so having spent a couple decades of my life there and seeing what that what that impact really meant, things that just became such a burden that others take for granted in terms of access to health care, but also other things, just general services, and understand the impact on people's lives, Particularly around cancer, which is my passion to study, is has been a driving force for me.
Heather Simonsen: Do you kind of ever think back to your time in Vermont and your neighbors and loved ones there and think of them when you're thinking of patients?
Tracy Onega: Absolutely, yeah. I mean, I know you know firsthand individuals. They made complete treatment decisions based on access. You know, they, for instance, with breast cancer, rather than have to come in for radiation, which they felt they could not drive two and a half hours, even potentially in snow and ice. For that radiation treatment daily for several weeks, they opted for a much more intense radical surgery of total mastectomy, which can be very appropriate, but wasn't necessary. In that case, it was a decision you could they could have done a more limited surgery or that one, and they made that choice because of that travel burden.
Heather Simonsen: Exactly, and that's a perfect segue into telemedicine, which I'd really like to dive into. And so how would you describe the importance of telemedicine, especially for rural Americans.
Tracy Onega: Telemedicine, I think we found from COVID, is hugely important, and we want to make sure that others are able to everyone can benefit from real time symptom monitoring. If you're having chemotherapy, for instance, and you're experiencing symptoms, you know, can you understand those symptoms in real time? Feed them back. Tell your health care provider. This is what I was experiencing over this time. Should I do I need to worry about this? Do I need to be seen? You-Those kinds of things are related to, you know, the technology that we have now and so can provide that kind of sort of next level patient care. But also, if you're tied to physically coming to your health care provider every time you have concern about your care, especially for cancer patients, that's just multiplied and amplified over the course of their treatment, months, sometimes years, then it's not even just the patient, but their caregivers, their loved ones, people who help support their care process. You know that could be anything to an hour 2,3,4, hours away. And I'll just say one more thing, if you if you're unable to do that, or sometimes Sure, you can maybe be seen locally, where you are not necessarily by your oncology team if you're a cancer patient. But then we do run the risk of care fragmentation. And you know, how smooth Can you continue in your care with everyone on your care team knowing all the information that they need to when they need to know it?
Expert Insights: Care Fragmentation in rural healthcare (17:10)
Heather Simonsen: Yeah, what is care fragmentation?
Tracy Onega: Well, it's almost thinking like a medical home for your care list. So, everything going on with you medically, let's just take the case for cancer patients related to your cancer care is seamlessly known by your care providers, your care team. So, for instance, if you're out in your community, not where your oncology team is, and you need to be seen at your local hospital, maybe you've had to go to the ER for some reaction to your therapy. Does that provider now in your community, locally have an idea of what is your chemotherapy regimen? What cancer care are you undergoing? What could they expect from these side effects given the you know, prior treatment you've been on, and then likewise, you know, if you now come back to your care team, do they know what happened when you were out in your community related to that symptom, for instance. So, kind of its thinking about weaving the pieces, the strands of all the care, together into like one fabric that that your team can understand.
Heather Simonsen: Oh, that's interesting. I hadn't thought about that. So, the benefit of you knows, more people on the team, meeting of the minds, but then keeping that information straight, and so it can be beneficial to the patient. Is that-?
Tracy Onega: Exactly! Yeah, and I'll just say Heather that you know, with telemedicine and thinking particularly around our rural, rural patients, you know, the idea really isn't to substitute actual care in the in the facility with your oncologist or your providers. It's not substitute that and have everything just be on a screen and remotely not at all. It's really thought you, I think most people want to have that, you know, that relationship with their providers, particularly something so impactful in one's life, like cancer. And indeed, you know there's really no way to not be have to come to a facility or clinic hospital. So given that you know what we want to do, what we see for telehealth is really the ability to kind of augment, augment the ability for the for that cancer care team, to provide more care, like be more in touch, have a better sort of view into the patient's life when they're not, you know, other than the few hours that they happen to be in the clinic, and for the patients to feel that kind of support, have more readily ready access or readily accessible support from their providers without having to do that travel, and yet still be able to have that support.
Heather Simonsen: So, it's really taking care of the things that can be easily addressed through telemedicine to strengthen that one-on-one relationship.
Tracy Onega: Exactly, right? So, for instance, you know somebody would always have to come to the hospital for safe surgery for your cancer, but you can do a lot of the preoperative work by telehealth prior to. To that surgery. Post operatively. You can get, you can get that post operative once you're released from the hospital, when it's safe to go home, you can continue to have support check ins, like, how you know, how is, how are your symptoms? How is, how is your healing going on? And this can happen then remotely and not have to have the burden of the travel. And same with chemotherapy, you'll have to come in for the infusions somewhere, some clinic, but perhaps you're having a you know, if you're having symptoms or a difficult time reaction to the chemotherapy, you can have that real time support to understand, you know, how to handle that best, or if you do need to be seen again.
Dr. Onega’s Research Journey: Telehealth for Rural Cancer Patients (20:46)
Heather Simonsen: So, you recently published some research on Medicare and interstate travel. Could you tell us about this study and why you decided to dive into it.
Tracy Onega: Well, I'm very interested in research on telehealth in cancer specifically, and what are the access or pain points to access for telehealth for cancer patients, and one of those is around physician licensing and being able to actually provide care across state lines. So, if you're an oncologist, say, in Utah, and you have a patient life in Montana, there is a limit to what you can deliver to them in terms of your cancer care unless that physician is licensed in Montana. And it's true that some states have reciprocity, so meaning that, you know, if you're licensed in Utah, maybe the state next to you accepts that license without having to be, you know, newly licensed in their state. But that's limited, and so this has limitations in the provision of cancer care. So, we really want to understand well, how much care is being provided across the states, that if we only had, like in our ideal world, this physician licensing wasn't such an issue. It was really around the you know, the patient and the provider, they have that they have that established relationship. How much would that be affected or approved if we didn't have these kinds of constraints?
Heather Simonsen: So, what were the results of the study?
Tracy Onega: So, we use the Medicare population, because that is really the way we can look nationally. We wanted to be able to understand across the entire country what might be what can we estimate this impact is for people who want to or are actually getting care out of state for cancer, we found that about 8% of cancer care in the Medicare population was happening across state lines. But what I think is most important perhaps, is that when we look by rurality, so from going from urban to rural categories, for the rural individuals, it was two to four times higher. So, for instance, for surgery, it could be up to almost 20% have to go out of state to get that cancer directed surgery. And the same was true for chemotherapy and radiation, not quite as high, but, you know, almost 15 or so percent. But we can see, again from the study, because of some other analyzes, that often they must go across the state, cross state lines in order to access those services. And so, you know that can be great if they're, you know, they're able to get to the center that maybe has the best care for their type of cancer. But at the same time, we understand that there will be that burden, and the implications for this are seeing that cross state travel again. How can we use that, that evidence to provide now information and data to support policies that will help expand the access of telehealth.
Heather Simonsen: And broadband and access to internet would be a big part of that. "Yes, exactly". Is this something the results of your study? Could it help create broader support that could eventually help the patient who would need to buy into this approach, telemedicine and licensure across state lines?
Tracy Onega: Yeah, of course. Top will be the patient, always patients and their support groups, caregivers and making sure that this is a technology that works for them, that you know is beneficial, that they feel comfortable using. And so, we're advancing in that way. Next would be, I think, providers and care teams, again, making sure that that's sort of helping them deliver the best care, and that in a way that they can and feel also comfortable doing. Third would be health care systems or health cancer centers, etc. They want to be providing this care. They want to not have care fragmentation, etc., and they can't afford to license every doctor everywhere. So, you know, how can that be made possible for them to extend their services across the populations? And then finally, would be payers like, you know, Medicare and other insurance companies or payers, because in the end, you know, it has shown, been shown to have some cost effectiveness, but you know, we want the coverage to be there, both for the patients and for the for these systems not to go bankrupt and be able to provide that care. So, it's helpful to show that this is actually effective and can save money while saving patients burden and improving their outcomes. And. And their care pathways.
Heather Simonsen: Makes so much sense. What are your final thoughts about rural health care and how technology can help narrow the access gap for people living in these beautiful areas?
Tracy Onega: Yeah, I think, you know, I guess it's kind of like two, I think two sides of the same coin, which the one side of the coin is we have so much improvement in cancer care technologies coming along really benefiting patient outcomes. People are living longer and better lives even after a cancer diagnosis. So, we want to make sure that people who are far away can have all those same benefits. So really, this technology, getting that technology can really be supported with telehealth, and at the same time, you know, we can sort of minimize the burden without having to do that extra travel as often for them and their loved ones.
Heather Simonsen: Tracy, thank you so much. This has been a wonderful conversation and thank you. Thank you so much for the great work you're doing. Thank you so much. Thank you to Lynette Phillips, Heather Peterson, Lucia Benitez, and Dr Tracy Onega for joining us today. To our dedicated listeners, we're so thankful for your support, for additional resources. Be sure to check out our show notes, and if you want to stay connected with us and be the first to know about upcoming episodes, subscribe on your favorite podcast platform. Please log on to Apple podcasts and leave us a five-star review. This helps other people like you find this podcast. If you have any questions, comments, suggestions for future episodes or a personal story you'd like to share, please visit our website, huntsmancancer.org. Mixing by Trent cell theme music composed by mix at six studios. Additional music from art list. I'm your host. Heather Simonson, a special thanks to the Huntsman Cancer Institute Communications and Public Affairs team.