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Access to high-quality cancer care remains inconsistent across the United States, with rural communities facing persistent and well-documented barriers. According to the National Cancer Institute, approximately 62% of US counties are classified as rural, with approximately 50 million people residing in these areas.¹ These communities often face systemic challenges that limit access to timely, comprehensive oncology care.
Geographic distance is one of the most significant barriers to cancer care in rural communities. Longer travel distances are associated with reduced treatment adherence, delays in care, lower rates of guideline-concordant care, and poorer outcomes for some patients.² This travel burden is not merely an inconvenience; it has meaningful clinical implications. For many patients, the logistical and financial strain of travel can significantly impact their ability to receive evidence-based care.
Compounding these challenges is a persistent shortage of oncology providers in rural regions. Although the overall number of oncologists in the US has grown in recent years, this increase has not kept pace with rising cancer incidence and demand for services. Additionally, the existing workforce is disproportionately concentrated in metropolitan areas, with fewer than 10% of medical oncologists practicing in rural settings. This imbalance contributes to the emergence of “cancer deserts,” regions where access to oncology care is severely limited or nonexistent. Projections indicate that this gap will persist, and even worsen, by 2037.³
Addressing these disparities is critical to ensuring equitable cancer care delivery. Community Hospital Cancer Center has developed a model designed to close this gap by integrating telehealth, outreach clinics, and advanced practice provider (APP) training. Supported by a multidisciplinary infrastructure, including a cancer committee, tumor board, tumor registry, and standardized chemotherapy protocols, this approach enables data-driven, team-based care that meets national standards. By leveraging technology and local capacity, the program delivers high-quality cancer care comparable to urban centers while keeping patients close to home.
Community Hospital’s vision is to deliver high-quality cancer care to a region that would otherwise remain underserved. While outreach clinics are commonly used in rural settings to extend specialty services, simply bringing an oncologist into a community is not sufficient to fully address the complex barriers patients face. These efforts are critical for improving access, but they represent only one component of a more integrated solution.
Community Hospital in McCook, Nebraska, is a critical access hospital serving southwest Nebraska, northwest Kansas, and eastern Colorado. Many patients travel one to two hours each way for oncology appointments and treatments, creating significant barriers to timely and consistent care. To address these challenges, the cancer program developed a multidisciplinary framework tailored to the realities of rural health care by integrating technology, outreach services, care coordination, workforce development, and data-driven quality improvement. The development of this model was supported by strong alignment among physician leadership, hospital administration, and operational teams, all of whom recognized that expanding access to oncology care was a strategic priority for the region.
Key components of the strategy included the establishment of a Cancer Committee, multidisciplinary tumor board, tumor registry services, oncology workforce development initiatives, and standardized chemotherapy treatment plans aligned with National Comprehensive Cancer Network (NCCN®) Guidelines.® Together, these elements created the foundation for a scalable, team-based model designed to deliver comprehensive cancer care closer to home while maintaining national standards of quality and safety. Below are key solutions developed and implemented to support this model.
As Community Hospital serves patients throughout southwest Nebraska, northwest Kansas, and eastern Colorado, telehealth became a key component of care delivery.
Rather than functioning as a stand-alone service, telehealth was integrated into routine oncology operations across the region. Virtual visits allow the medical oncologist to conduct consultations, review laboratory results, assess treatment tolerance, and complete follow-up appointments while patients remain in facilities closer to home. This approach reduces travel burden while maintaining continuity with a single oncology provider, regardless of where patients receive care. Telehealth also serves as an important bridge between outreach visits, ensuring patients have timely access to oncology expertise without frequent long-distance travel.
Beyond improving patient access, telehealth has also enhanced physician flexibility and engagement. Recruiting specialists to rural communities remains a significant challenge, and providers are often asked to travel extensively between locations to support outreach efforts. By incorporating telehealth into the care model, the medical oncologist can evaluate and manage patients across multiple sites without being physically present at each location. This flexibility allows providers to maintain broader regional coverage while reducing unnecessary travel and improving efficiency. For rural cancer programs facing workforce shortages, telehealth can serve not only as a patient access solution but also as a valuable recruitment and retention strategy, enabling specialists to extend their reach while maintaining a more sustainable practice model.
Recognizing that virtual care alone cannot meet all patient needs, Community Hospital established outreach clinics in Colby, Kansas, and Wray, Colorado. These locations were selected based on community need, patient volume, and their distance from comprehensive oncology services.
Clinic frequency is adjusted according to demand. Medical oncology services are currently provided twice monthly in Colby, with additional clinic days under consideration as volumes continue to grow. In Wray, oncology services are provided monthly. Outreach schedules are intentionally coordinated to ensure the oncologist remains available at the main campus while extending services across the region. The hybrid model allows patients to receive in-person evaluations, treatment planning, and ongoing care locally while maintaining access to specialized oncology expertise.
A successful rural oncology program requires more than physician availability; it requires a knowledgeable and engaged local team. Like many critical access hospitals, Community Hospital faces ongoing workforce challenges and a limited pool of oncology-experienced clinicians.
To build local expertise, the program invests heavily in professional development for APPs, nurses, navigators, pharmacists, and support staff. Team members utilize educational resources from organizations such as the Association of Cancer Care Centers (ACCC), Oncology Nursing Society (ONS), American Cancer Society (ACS), and NCCN. Education is further supported through physician-led learning opportunities, including monthly oncology-focused discussions, journal article reviews, and case-based education sessions conducted before tumor board meetings. These efforts have helped create a culture of continuous learning and strengthen the team’s ability to provide high-quality oncology care in a rural setting.
As the program expanded, multidisciplinary coordination became essential to maintaining quality, consistency, and communication across multiple locations. Recognizing that comprehensive cancer care extends beyond physician visits and treatment administration, Community Hospital developed an infrastructure designed to support patients throughout the continuum of care.
The first step was establishing a service line leadership team with representation from medical oncology, radiation oncology, infusion services, pharmacy, and nurse navigation. This team meets regularly to review operations, address barriers, coordinate workflows, and identify opportunities for improvement. Having leaders from multiple disciplines involved in decision-making helps ensure that operational changes consider the impact across the entire patient journey rather than within individual departments.
To further strengthen coordination, Community Hospital established a Cancer Committee that oversees the oncology program and supports compliance with the Commission on Cancer standards. The committee includes representation from medical oncology, radiation oncology, surgery, nursing, pharmacy, nutrition services, rehabilitation services, administration, and other departments involved in cancer care. This broad representation helps ensure that patients have access not only to treatment but also to supportive services that improve quality of life and outcomes. The committee regularly reviews quality measures, emergency department utilization, hospital admissions, service needs, and opportunities to improve cancer care throughout the organization.
Building upon this foundation, Community Hospital implemented a monthly multidisciplinary tumor board that includes providers from medical oncology, radiation oncology, surgery, radiology, pathology, pharmacy, and nurse navigation. Cases are reviewed collaboratively to ensure treatment recommendations are evidence-based, coordinated, and tailored to each patient’s specific needs. For a rural cancer program, the tumor board serves an especially important role because many patients receive portions of their care at multiple facilities. The collaborative review process ensures that providers remain aligned and that patients benefit from the same multidisciplinary approach commonly found at larger urban cancer centers.
To support long-term quality improvement, Community Hospital has also implemented dedicated tumor registry services. Historically, cancer cases were reported directly to the state registry through the Health Information Management Department, limiting the organization’s ability to analyze its own cancer data. While the registry staff is currently focused on abstracting historical cases and building the database, the registry provides valuable insights into patient demographics, disease patterns, treatment trends, outcomes, and program performance. This data supports strategic planning, accreditation efforts, quality improvement initiatives, and future decision-making across the service line.
Together, the service line leadership team, Cancer Committee, tumor board, and tumor registry create a framework for continuous improvement and coordinated patient care. By bringing multiple disciplines together around shared goals, Community Hospital has established a rural oncology infrastructure that supports evidence-based treatment, collaboration, and comprehensive care close to home.
To ensure consistency and safety across all sites of care, Community Hospital’s pharmacy team developed chemotherapy treatment templates within the electronic health record (EHR) based on NCCN Guidelines.
Standardized treatment plans improve workflow efficiency, reduce variation in care, support patient safety, and help ensure that evidence-based treatment protocols are followed regardless of treatment location. This standardization has been particularly important as the program expanded services across multiple facilities and states.
Together, these solutions created a scalable model that combines telehealth, outreach services, workforce development, multidisciplinary collaboration, and evidence-based standardization to deliver comprehensive cancer care closer to home for rural patients.
Successful rural oncology programs require more than clinical expertise—they depend on strong community relationships, coordinated operations, and a clear strategy for bringing care closer to home. Community Hospital Cancer Center has intentionally designed its model around these principles.
Patients generally prefer to receive cancer care in their hometowns or as close to home as possible. For rural patients, repeated travel for consultations, chemotherapy, imaging, and follow-up visits can create significant financial, logistical, and emotional burdens, making local access to oncology services an important component of equitable cancer care.⁴ To make this possible, oncology leaders actively engage referring providers throughout the region. As a service line director, this often means serving in a business development role by meeting with primary care providers, hospital administrators, and specialists in neighboring communities to build referral pathways and ensure patients can access oncology services locally. These relationships are critical to creating a seamless referral process and keeping patients connected to care within their communities.
Community awareness is equally important. Expanding access requires more than offering services—it requires ensuring patients know those services exist. In many rural settings, patients become accustomed to traveling long distances for care because they are unaware of local treatment options. Community Hospital has worked to increase awareness through physician engagement opportunities, community events, marketing efforts, and direct outreach to local health care providers. These activities build trust and reinforce the message that high-quality cancer care can be delivered close to home.
Once patients enter the oncology program, care coordination becomes essential. Oncology care is inherently complex, and many patients receive laboratory testing, imaging, surgical services, or other treatments at multiple facilities. Gathering pathology reports, imaging studies, and medical records from various organizations can quickly become overwhelming for patients and providers alike. Nurse navigation serves as a central component of the model, helping patients understand their treatment plans, coordinate appointments, and navigate care across multiple sites.
The integration of telehealth and in-person care requires intentional scheduling and operational planning. Telehealth visits are incorporated into clinic days, allowing the medical oncologist to evaluate patients, review laboratory results, and conduct treatment visits remotely, while patients remain at locations closer to home. This hybrid approach maximizes physician availability across multiple sites while maintaining continuity of care. Scheduling is carefully coordinated to balance outreach responsibilities, telehealth visits, and on-site clinical care.
Finally, the model depends on engaged providers and staff. The physician’s role extends beyond direct patient care to include mentorship, education, and clinical leadership. Ongoing training and support help develop oncology knowledge and confidence of APPs, nurses, and support staff, allowing them to manage day-to-day patient needs while maintaining high-quality care. This investment in local expertise creates a more resilient oncology program and ensures patients receive consistent, coordinated care regardless of where they enter the system.
Implementing a rural outreach oncology program is far more complex than simply scheduling clinic space and sending a physician to alternate locations. Each outreach site operates as its own healthcare ecosystem, with unique workflows, staffing models, technology platforms, and operational priorities. Successfully integrating oncology services across multiple organizations requires extensive planning, flexibility, and ongoing collaboration.
One of the first challenges the Community Hospital team encountered was determining how to manage clinical documentation and order entry across multiple EHR systems. Because each outreach location utilizes a different EHR, there was initial discussion about using a single system for all patients. Ultimately, it was determined that documenting within each site’s EHR was the most effective solution. This approach ensured that laboratory orders, treatment plans, provider notes, and billing documentation remained within the local system, reducing administrative burden and eliminating the need for excessive faxing or duplicate documentation. Establishing workflows that worked within each site’s existing infrastructure required numerous planning meetings and careful coordination before services could begin.
Chemotherapy administration presented another significant challenge. Although each outreach location has a team of chemotherapy-certified nurses, it was critical to ensure that patients received consistent education, preparation, and support regardless of where they received treatment. To address this need, telehealth visits were incorporated into the care model to supplement outreach clinics. These visits allow the oncologist to review treatment plans, discuss potential adverse effects, answer patient questions, and reinforce education before treatment is administered, helping create a more consistent patient experience across all locations.
Pharmacy support also required careful consideration. It is unique that a critical access hospital has an on-site pharmacist with oncology expertise, with some facilities lacking the infrastructure necessary to safely prepare chemotherapy. Community Hospital pharmacists serve as an important clinical resource for outreach partners, but pharmacy regulations and state licensure requirements create additional challenges when operating across state lines. Before launching outreach services, organizations carefully evaluate their medication preparation capabilities, drug-handling processes, and applicable regulatory requirements.
Perhaps the most important lesson learned throughout this process is the value of proactive communication. Challenges will arise whenever multiple organizations work together, regardless of how much planning occurs beforehand. Regular communication builds trust and provides a mechanism to identify and resolve issues before they affect patient care. At Community Hospital, this communication occurs through monthly operational meetings with each outreach location, where leaders review patient volumes, scheduling concerns, workflow challenges, staffing issues, and opportunities for program growth. These meetings create a structured forum for discussing concerns and aligning expectations across organizations.
Equally important are the informal communication channels that develop over time. Key leaders and clinical staff maintain direct access to one another through phone calls and text messaging, allowing questions and urgent issues to be addressed in real time. In a rural outreach model, providers and leaders frequently travel or work across multiple locations, making immediate communication essential. While email remains valuable for documentation and long-term planning, many operational issues require a more direct and timely response. Having established relationships and direct lines of communication allows teams to quickly resolve challenges related to scheduling, treatment coordination, pharmacy support, and patient needs. These ongoing conversations have proven essential to maintaining strong partnerships and ensuring the continued success of the program.
Ultimately, our experience has shown that rural oncology outreach is built on relationships. Technology, infrastructure, and clinical expertise are all important, but sustained success depends on collaboration, transparency, and a commitment to continuous communication among all partners involved in patient care.
As a newer program, Community Hospital Cancer Center is still building the data infrastructure necessary to evaluate long-term clinical outcomes, utilization trends, and quality metrics. With the recent development of tumor registry services and ongoing case abstraction efforts, additional data regarding treatment outcomes, emergency department utilization, hospital admissions, and other quality indicators will become available over time. However, one significant impact is already evident: improved access to cancer care for rural patients.
Before the establishment of oncology services at Community Hospital and its outreach locations, many patients faced substantial travel burdens to access specialty cancer care. Patients in southwest Nebraska often traveled to larger regional centers, including North Platte, approximately 70 miles from McCook. For patients in communities such as Wray, Colorado, specialty oncology services frequently required travel to metropolitan areas such as Denver, often resulting in several hours of travel for appointments, consultations, and treatment.
By bringing oncology services directly into rural communities through telehealth and outreach clinics, Community Hospital Cancer Center has expanded access to care in regions that might otherwise be considered oncology “deserts.” Patients can now receive consultations, treatment planning, follow-up visits, and many therapies much closer to home. This reduction in travel burden not only improves convenience for patients and caregivers but also removes a significant barrier to care that has historically affected rural populations.
The impact extends beyond individual patient encounters. Telehealth services allow patients to connect with an oncologist without crossing state lines or traveling long distances, while outreach clinics ensure that in-person assessments remain available when needed. Together, these services create a sustainable model that increases access across southwest Nebraska, northwest Kansas, and eastern Colorado.
Although long-term clinical outcomes are still being evaluated, the program has already demonstrated that a combination of telehealth, outreach services, and local workforce development can successfully expand access to oncology care in historically underserved rural communities. For many patients, the greatest benefit is simple but meaningful: receiving high-quality cancer care closer to home, supported by a multidisciplinary team committed to meeting their needs.
The greatest benefit of this model is the ability to deliver high-quality cancer care close to home. For patients and families, reducing the need for frequent long-distance travel decreases both the financial and emotional burden of treatment. Cancer care is challenging enough without requiring patients to spend hours on the road for appointments, treatments, or follow-up visits. Through the integration of telehealth, outreach clinics, and local treatment options, patients can receive much of their care within their own communities while still benefiting from the expertise and resources typically associated with larger cancer centers. Multidisciplinary services such as the Cancer Committee and tumor board further strengthen care delivery by bringing providers together to review cases, coordinate treatment plans, and ensure that patients receive evidence-based recommendations regardless of where they enter the health care system.
The model also creates significant benefits for providers and the cancer program. Rural health care is uniquely personal—many patients are not just members of the community; they are friends, neighbors, coworkers, and family members. Keeping care local allows providers to maintain those relationships while supporting patients throughout their cancer journey. At the program level, collaboration among physicians, APPs, nurses, pharmacists, navigators, and outreach partners has fostered a more integrated and sustainable oncology service line. By investing in workforce development, multidisciplinary coordination, and regional partnerships, Community Hospital Cancer Center has created a model that not only expands access but also strengthens the long-term viability of rural cancer care across the region.
There is no single solution to addressing rural oncology access, and every community has unique needs. However, several foundational elements can help organizations determine whether an outreach model is feasible and sustainable. For smaller critical access hospitals, the first step is to evaluate the ability to safely support an oncology service. This includes assessing infusion capabilities, chemotherapy administration practices, nursing competencies, and pharmacy support. Even if a site does not initially have a visiting oncologist, investing in oncology education for nurses, APPs, pharmacists, and support staff creates a foundation for future growth. Organizations should also evaluate local demographics, cancer incidence, and referral patterns to understand potential patient volume and determine whether services can be supported. Once that assessment is complete, hospitals can begin discussions with regional cancer centers regarding outreach partnerships, physician coverage, and opportunities to integrate telehealth into treatment and follow-up care. Having a clear understanding of community needs and expected volume will help define clinic frequency, staffing requirements, and operational workflows.
For established cancer centers seeking to expand into surrounding communities, the process begins with data. Understanding where patients currently travel for care, identifying underserved regions, and evaluating referral trends can help prioritize outreach opportunities. Equally important is assessing the capabilities of potential partner sites, particularly pharmacy support, chemotherapy preparation processes, and staffing resources. When limitations exist, cancer centers can often provide clinical expertise, treatment plan review, pharmacy consultation, education, and telehealth support to bridge those gaps. Regardless of program size, workforce development should remain a priority. Organizations do not need to develop educational programs from scratch; resources from ACCC, ONS, NCCN, ACS, and other professional organizations provide a wealth of training opportunities and best practices. Finally, identify physicians and clinical champions who are passionate about education and mentorship. Sustainable rural oncology programs are built not only on technology and infrastructure but also on committed leaders who invest in developing the next generation of oncology professionals and strengthening care within their communities.
William Goodenkauf, MBA, MS, CCES is the Director of the Oncology Service Line at Community Hospital in McCook, Nebraska.
