Pilot Program Launching to Increase Access to Cancer Care for Rural Montanans

Unique Partnership with Montana-based Organizations Forms Foundation of “Hub-and-Spoke” Care Delivery
For immediate release
October 11, 2022


Elaiza Torralba

Alexandria, VA. – Building on its longstanding commitment to health equity, the American Society of Clinical Oncology (ASCO) is launching a multi-year pilot program to increase access to high-quality, equitable cancer care in rural Montana. The ASCO pilot program will enable patients to receive cancer care in their own community through a hub-and-spoke care delivery model, a proven method of extending access to cancer care in rural and remote areas.1 This initiative, which aligns with the Montana Cancer Coalition’s comprehensive cancer control strategy,2 aims to reduce patients' commute to treatment locations, enable rural sites to be primary points of contact, improve care delivery through education and training, and encourage patient engagement throughout the cancer care continuum.

The Increasing Access to Cancer Care in Rural Montana pilot program involves Bozeman Health Cancer Center, located at Bozeman Health Deaconess Hospital, a regional facility that serves as the initiative’s “hub,” and Barrett Hospital & HealthCare, a community-based non-profit Critical Access Hospital and medical clinic provider in Dillon that serves as the “spoke.” It will also enlist the assistance of the Mark and Robyn Jones College of Nursing at Montana State University, the only nursing graduate program in Montana, offering a potential pipeline to build a trained nursing workforce that can increase capacity and care delivery at participating community-based, or spoke, clinics.

“This innovative program addresses a very real problem in a concrete, tangible way. It takes advantage of resources and experts in the Montana cancer ecosystem while bringing cancer care closer to communities where patients live,” said ASCO President Eric P. Winer, MD, FASCO. “We are thrilled to be working in Montana to inform care delivery models and strategies that can be used in other rural or under-resourced areas throughout the U.S. and beyond.”

Approximately 15% to 19% of the U.S. population lives in rural areas outside of major metropolitan centers, which is associated with worse cancer outcomes. Research has shown, for example, that cancer death rates are higher in rural versus urban areas—180 deaths per 100,000 versus 158 deaths per 100,000, respectively.3 Compared to those living in urban and suburban areas, patients with cancer in rural communities have higher rates of behavioral risk factors and are at increased risk to receive late-stage diagnoses and experience higher cancer-related death rates. Combined with limited access to screening and treatment, these factors contribute to health disparities.4

Cancer is the second leading cause of death in Montana and, as one of the least densely populated states in the United States, almost half (45%) of the state’s residents live outside of incorporated cities and towns.  More than three-quarters (76%) of individuals live in areas classified as rural and frontier. Further, Montana has a higher Native American population than other states and a considerably lower than national average median household income.5 These population and income disparities amplify the burdens associated with traveling long distances to access specialty care.

“One of the overall goals of the pilot program is to equip cancer care practitioners with specific solutions on how to deliver quality care to patients in historically underserved regions, as well as enable patients to receive the care they need at locations that are conveniently located,” said Jack Hensold, MD, Chair of the ASCO Rural Cancer Care Taskforce and Medical Director of Regional Outreach at Bozeman Health. “This is about meeting patients where they are, which includes building trust with them, enlisting the support of community-based organizations, involving trusted community leaders, and building a collaboration network that enables all patients with cancer to be served.”

Rural and small community hospitals often do not have the capacity, infrastructure, or workforce to deliver on-site cancer care services, resulting in patients having to travel long distances to receive treatment. Through the consistent delivery of evidence-based health care, the pilot program’s overall goal is to improve cancer outcomes in rural communities through the delivery of care closer to where patients live. Additionally, it will enable patients to receive high-quality care that meets expected standards.

“This [program] is a tremendous first step in the prevention and treatment of cancer in rural communities. We are so pleased that patients in southwestern Montana will now have access to the same high-quality cancer care services and resources while maintaining the comfort and convenience of their local community,” said Carolyn Hansen, Chief Clinical Officer at Barrett Hospital & HealthCare.

Non-oncology professionals or individuals in health assistance roles will play a significant part in providing support, both during treatment and as individuals enter their survivorship phase. The hope is that effective coordination of care will also lead to improved health outcomes and reduced out-of-pocket costs associated with traveling long distances for ongoing specialty care.

The five-year pilot program will be regularly assessed, and project findings will be shared through publications, presentations, and other communications. Based on insights from the program, ASCO will develop a blueprint of best practices and resources that can support scaling the program to other areas.6

The Increasing Access to Cancer Care in Rural Montana pilot program is made possible by funding from Conquer Cancer®, the ASCO Foundation, which received a generous grant from the Merck Foundation’s Alliance for Equity in Cancer Care to support this pilot.

“One quarter of people in the U.S. live in rural communities. The challenges they face in accessing cancer care are different from the obstacles faced by urban dwellers. We are grateful that the Merck Foundation has chosen to include the Montana State University Mark and Robyn Jones College of Nursing program among these funded projects to ensure that rural needs are not overlooked. Rural and frontier communities deserve high quality health care, including cancer care, and Dr. Hammersla and her team are well positioned to discover innovative and practical solutions,” said Sarah Shannon, Dean of the Mark and Robyn Jones College of Nursing.

As part of its ongoing work to address equity in cancer care, ASCO has examined opportunities to close the rural cancer care gap and increase access for patients in rural areas. In 2018, ASCO held town hall sessions to listen and learn from patients, especially those living in rural areas. Since then, ASCO announced other resources for members, including a task force to address and reduce barriers to rural cancer care access; an article on closing the rural cancer care gap in the State of Cancer Care in America series; and a media issue brief providing key background information for journalists. The pilot program serves as an integral part of ASCO’s Equity, Diversity, and Inclusion Action Plan and mission, ensuring access to high-quality, equitable cancer care to patients in rural and low-resource settings through research, education, and capacity-building initiatives.

Learn more about ASCO's health equity efforts.

Additional Resources:


1. Zon, R. T., Kennedy, E. B., Adelson, K., Blau, S., Dickson, N., Gill, D., Laferriere, N., Lopez, A. M., Mulvey, T. M., Patt, D., Pickard, T. A., Purdom, T., Royce, T. J., Sumrall, A. L., & Page, R. D. (2021, September). Telehealth in Oncology: ASCO Standards and Practice Recommendations. JCO Oncology Practice, 17(9), 546–564. https://doi.org/10.1200/op.21.00438

2. Montana Cancer Coalition Comprehensive Cancer Control Plan 2016-2021: https://mtcancercoalition.org/wp-content/uploads/2020/04/2016-2021-MCCP-Goals-Objectives.docx

3. Garcia MC, Faul M, Massetti G, et al. Reducing potentially excess deaths from the five leading causes of death in the rural United States. MMWR Surveill Summ 2017;66(No. SS-2).

4. US Census Bureau: American community survey. 2017 data release. https://www.census.gov/programs-surveys/acs

5. National Cancer Institute and Centers for Disease Control and Prevention, State Cancer Profiles: Montana, 2015.

6. Laura A. Levit, Leslie Byatt, Alan P. Lyss, Electra D. Paskett, Kathryn Levit, Kelsey Kirkwood, Caroline Schenkel, and Richard L. Schilsky. Closing the Rural Cancer Care Gap: Three Institutional Approaches. JCO Oncology Practice 2020 16:7, 422-430.

About ASCO: 

Founded in 1964, the American Society of Clinical Oncology, Inc. (ASCO®) is committed to making a world of difference in cancer care. As the world’s leading organization of its kind, ASCO represents nearly 45,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of the highest-quality patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation. Learn more at www.ASCO.org, explore patient education resources at www.Cancer.Net, and follow us on Facebook, Twitter, LinkedIn, and YouTube.