Distance, Telehealth Access Complicate Cancer Care in the Mountain West

In part 1 of an interview with Christos Vaklavas, MD, of the Huntsman Cancer Institute, at last week’s Institute for Value-Based Medicine® event in Salt Lake City, Utah, he discussed the significant geographic challenges facing patients in Utah and the broader Mountain West region served by the Huntsman Cancer Institute, which covers roughly 17% of the continental US.

Vaklavas, who was a part of the “Advancing Patient-Centered Oncology in Utah: Navigating Barriers to Care” panel, described this catchment area as vast but isolated, with Huntsman Cancer Institute functioning as the region's sole comprehensive cancer center. Distance is unquestionably the biggest barrier patients face when seeking specialized medical attention, he said, particularly for those with complex or rare conditions requiring expert-level care unavailable closer to home.

To address this challenge, Vaklavas highlighted that Huntsman Cancer Institute has implemented several targeted strategies. For patients living more than 100 miles from the institute, the center provides low- or no-cost housing for the full duration of treatment. Those enrolled in clinical trials also receive financial support through gas cards and stipends to help offset travel expenses. While helpful, Vaklavas acknowledged that these measures do not fully solve the underlying problem but mitigate the burden that distance imposes, as truly specialized care can only be delivered at specialized centers.

Beyond direct financial support, Huntsman Cancer Institute has built a network of partnerships with regional hospitals and practices, a model he referred to as "spoke and kingpin." This system allows for 2-way knowledge exchange and patient referrals: patients travel to Huntsman Cancer Institute for specialized interventions, then return to local providers closer to home to receive ongoing standard-of-care treatment.

Regarding telehealth, Vaklavas noted that the COVID-19 pandemic forced rapid innovation, and virtual care delivery became one of the pandemic's few silver linings, advancing quickly as a care model. However, he expressed concern that progress has since reversed.

The primary regulatory obstacle preventing continuous telehealth care across state lines is licensing, as physicians must maintain active medical licenses in each state where they see patients, requiring institutions to weigh whether the patient volume in a given state justifies the administrative and financial burden of maintaining that license. Vaklavas concluded by characterizing the current retreat from pandemic-era telehealth flexibility as a step backward and arguing that reviving and broadening telehealth access should be a priority going forward.

“Telehealth, at least in my breast cancer practice, has been a nice project that moved forward very, very fast, but now it is being taken aback,” he said. “So, definitely something that has to be revived in the future.”