Carla Rider is sitting with her mother-in-law at a table in the common area. It has a kitchen with several stoves, stainless steel refrigerators and sinks. A few travel-size cereal boxes lie around for the taking.

We’re in a tall building in that part of midtown Nashville where so many hospitals and medical offices are. It’s the Hope Lodge, and it offers housing to cancer patients traveling here from rural areas.

On this hot afternoon, the Riders are one of a few families putting snacks together or chatting.

And Carla looks tired. The night before, she and her mother-in-law made the three-hour trip to Nashville from Crossville. And today, she had a chemo treatment.

She says getting to stay at the lodge has been a lifesaver, but that doesn’t mean it’s been easy.

“It involves, you know, someone to stay with you,” Carla said. “Someone to take care of your house while you’re gone. Someone to take care of your kids, your animals. We have two small children, and we have all kinds of animals. We have goats, chickens, dogs, a few birds.”

That being said, it’s a better alternative than three hours each direction for a long, hard day.

“You get up, you know, you get ready at 6 o’clock,” she said. “My appointment is at 8 o’clock. You might get home by 2 o’clock. That’s an all-day appointment — 3 days a week.”

Situations like the Riders‘ have become more common in Tennessee, as rural hospitals drop chemotherapy services.

Safety net hospitals dropping chemotherapy 

From 2014 to 2022, about half of the rural hospitals that once offered chemotherapy services cut the program. That’s according to a report from health care consulting firm Chartis, which looks into financial pressures on rural safety net hospitals. The report ranks Tennessee fourth in the nation for these losses.

There are a lot of factors playing into that, says Dr. Neil Hayes, the director of the Cancer Center at the University of Tennessee Health Science Center.

For one, chemotherapy drugs used to be pretty affordable. New, pricier drugs started coming out in the early 2000s, when Hayes was getting started as a cancer doctor.

“Patients would have to come up with several hundred dollars for drugs that were coming out at that time,” he said. “Whereas, previously, chemotherapy drugs and antibiotics might have been on a similar scale for cost.”

Now, they cost even more.

“It’s not uncommon for us to administer drugs that might have retail cost of, you know, $9,000, $10,000 per IV dose,” he said.

Nurses, doctors and pharmacists who specialize in oncology services are rare compared to a lot of other specialties, which means they’re more expensive.

And, oncology departments often have to use a special program for health records that other departments aren’t using — another expense. Hayes says health systems with multiple hospitals will often consolidate all their cancer services to one site to save money on costs like these.

There are some struggles on the pay side too. One example: Back in the day, Hayes says, doctors would have patients stay at the hospital for a few days if they were frail and having an especially hard time with their treatment — just to keep an eye on them.

“That rarely happens — and I mean, almost never — happens anymore,” he said. “And it’s not that we wouldn’t want to do it on occasion, but the insurance company might deny the admission and, you know, send the bill to the patient instead of paying for it.”

The toll on patients

That’s why options like the Hope Lodge are becoming even more necessary. It’s run by the American Cancer Society and offers no-cost accommodations to patients that live at least 40 miles from their treatment center.

Derek Calderara is the lodge’s senior manager. He says one of the most surprising things he learned was how quickly this disruption hits patients.

“Within a matter of days, certain things happen, and next thing you know, they’re out the door,” he said. “They’re here; they’re starting treatments. Which is incredible for the medical side of it. But from just being a human being, I can’t even begin to comprehend what that feels like: being yanked out of your home, being in this new environment … in a city where — if you’re not used to a city — Nashville is its own beast to process.”

Rider is down to one day a week of treatment, which means fewer hourslong treks down Interstate 40. But that took a while.

“I started in September of last year,” she said. “So it’s almost a year. I have a full year. Yeah, that’s what I’m saying. People don’t realize how in-depth it is, how long it takes.”