Eugene Huang, MD
Obtaining quality cancer care in Alaska is often difficult and expensive owing to the sparse highway network and the scattered nature of the state’s population of 736,000 people, who are spread out over more than a half-million square miles. For oncology practices, the use of local primary care providers to aid oncologists and recent advances in telemedicine have helped to overcome these barriers and increase the availability of cost-effective, evidence-based medicine.
For radiation and chemotherapy treatment spanning several weeks to months, patients may have to travel to one of the major population centers, such as Anchorage or Juneau, and live out of a hotel room throughout that time. Coupled with the medical expenses and the long-term leave from their job, the extended hotel stay puts an economic and emotional toll on patients and their families.
“Patients are in an unfamiliar environment and are going through one of the most difficult times of their lives,” said Eugene Huang, MD, medical director of the Southeast Radiation Oncology Center in Juneau. “The logistics are quite humbling.” Twenty-three of Alaska’s 27 boroughs and census areas are medically underserved areas/populations or governor-designated medically underserved populations, and they account for about 59 percent of the state’s residents.2
In addition, about 75 percent of communities in the state do not have road access to a community with a major hospital, meaning that many people need to travel by airplane, boat, or ferry to get treatment. Huang stated that some women with breast cancer will choose to undergo a mastectomy because it is less time-consuming and expensive than traveling to an urban center for radiation therapy, even if a less-invasive option is more appropriate.
Most medical and radiation oncologists are located in Anchorage, according to Matthew Olnes, MD, medical director of Hematology and Medical Oncology at Alaska Native Medical Center (ANMC), which treats a majority of the state’s far-flung native population, members of whom travel via complicated routes to reach centers of care. “A very typical pathway for them is to take a snow machine to get to the closest village that has an airstrip, then get on a propeller plane and fly to the largest regional city that has a jet, then get on the jet to fly to Anchorage,” said Olnes. “It’s literally a 12-hour trip for them, and they’re doing it every couple weeks for long-term treatment. It really wears them down.”
For the handful of independent oncology practices in Alaska, the patient base is more urban-suburban; however, a large proportion of those patients still must travel for treatment, making accommodations and rapid, well-coordinated care a priority for oncologists and other healthcare specialists who are a part of the effort.
Juneau is the third largest city in Alaska, with an estimated 32,406 residents in 2014;3
yet there is no road access from Juneau to the rest of the state. Before Huang opened his clinic in 2013, the closest radiation center was in Anchorage and required travel by plane or ferry. His $7 million center is located near the Bartlett Regional Hospital, which has an infusion center for patients undergoing chemotherapy.4
“Before we came to Juneau, patients would often omit doing their treatment because, logistically, it was too hard to travel or afford,” said Huang.
Key Role of Primary Care Providers
Because most of Alaska’s oncologists are in Anchorage and Fairbanks, primary care providers often perform tasks that, outside of Alaska, are typically done by oncologists. Larry Daugherty, MD, director of Radiation Oncology at the Alaska Cancer Treatment Center in Anchorage, described a situation in which a local primary care provider was tasked with administering prostate-specific antigen tests after radiation treatment for one of Daugherty’s patients who lived in Valdez (a town approximately 300 miles east of Anchorage).
Medical oncologists based in larger cities, such as Anchorage or Seattle, in Washington, also travel to small Alaskan communities once or twice per month and prescribe chemotherapy, which internists or trained nurses administer under an oncologist’s supervision. Between chemotherapy treatments, the primary care providers also manage side effects, such as chemotherapy-induced nausea, and monitor blood counts. “Primary care physicians are excellent up here,” said Huang. “They don’t always have specialists on hand, so their scope of practice is much broader than it might be in the lower 48 states.”