Cancer Center Takes Its Skills to Rural Virginia : Oncology: It is estimated that the program has saved about a million miles of travel for sufferers, who must go to Richmond only for such high-tech procedures as radiation and bone-marrow transplants.

Some days, nurse Connie Deagle’s job means chatting with Tamara Tuttle’s daughter Susie about her favorite movies while her mother visits the doctor.

Other times it means helping to administer a complex form of chemotherapy through a patient’s spine.

At night Deagle’s job as coordinator of Rappahannock General Hospital’s oncology clinic means taking calls at home from patients with questions about their cancer treatments.

The clinic at the 76-bed hospital is one of four cancer outreach partnerships that the Medical College of Virginia’s Massey Cancer Center in Richmond has established at small hospitals in the state.

Deagle, 39, who has lived in nearby Middlesex all her life, and her counterparts at the other clinics provide the human link that doctors at Massey say makes the project function effectively.

“They know more about the individual patients than I do,” said Dr. Christopher Desch, director of the program and one of two team oncologists. “When I say I don’t know if this guy can get back and forth to Richmond, they say, ‘Well, Uncle Barney can call Fred, and his next-door-neighbor’s kid will take him.’ ”

Recognizing that a major obstacle to cancer treatment in rural areas is lack of access to specialized care, doctors at Massey created the program in 1989. Oncologists from the center visit the rural hospitals every two weeks to treat patients and train local doctors and nurses to administer chemotherapy.

Patients in these areas must travel to Richmond only for such high-tech procedures as radiation and bone-marrow transplants.

The specialists estimate that the program has saved about a million miles of patient travel. They say it has tapped into a new group of cancer patients who would refuse treatment if it meant driving to a big city.

“We’ve had a lot of people say, ‘I’d rather die than come to Richmond,’ ” said Dr. Thomas Smith, the medical college’s director of cancer education and the other team oncologist.

Virginia’s cancer-mortality rate is the eighth-highest in the country, attributed in part to high levels of poverty, unemployment, illiteracy and elderly residents.

Cancer rates in other rural regions are rising, according to the National Cancer Institute. In his Sept. 22 speech on health-care reform, President Clinton called for more “strategic alliances between rural hospitals and urban health centers.”

One in four Americans lives in the country, often far from hospitals with the latest technology. “They represent a substantial part of the nation, but they’re a quieter, more stoic portion,” Desch said.

The Massey center’s rural health-care venture began in South Hill, Va., a tobacco-growing community near the North Carolina border. That program’s success led doctors to set up shop in Kilmarnock, a retirement and fishing community on the Chesapeake Bay, and in Farmville, a town in central Virginia. A similar program for nurses only was started recently in Grundy, near the Kentucky border.

The program’s success hasn’t meant profits either for the Virginia college or for the financially precarious hospitals.

Financing comes from an annual $250,000 state grant and $100,000 in hospital money and private donations. Most of the patients are on Medicare or Medicaid or are underinsured.

Rappahannock General hopes to open a new building soon for its overcrowded oncology clinic. Much of the $700,000 needed for the project will have to come from community donations, said hospital administrator Fred Baensch.

With an eye toward creating a national model for rural outreach, the college, the country’s fourth-largest academic medical center, is evaluating the overall financial impact of its program.

“We can show that you can provide superb care at the rural hospitals and the rural hospitals can at least break even,” Smith said. “What we can’t show yet is that all rural hospitals can do that.”

In fact, some researchers say that one standard program for rural outreach won’t work because of regional diversity.

“The Massey program is only one approach to improving cancer care in rural areas,” said Dr. Susan G. Nayfield, program director of cancer prevention and control at the National Cancer Institute. “There are other approaches that can be more suitable to the needs of other rural areas.”

Researchers at the University of Alabama, for example, are studying attitudes toward cancer in the state’s rural “Black Belt,” where beliefs about the disease differ from community to community, Nayfield said.

The home-grown nature of the Virginia program accounts for its comparative success, Smith said. Some hospitals’ idea of cancer outreach, he said, “is to get in a car with the chemotherapy, drive to a center, give it, bill it, then leave.”

At Massey, clinical nurse specialist Cynthia Simonson is reachable 24 hours a day to answer phone calls from the rural hospital nurses she has helped train in oncology. In turn, the rural nurses handle patient phone calls that Simonson, Smith and Desch don’t have time to take.

On “clinic day” at Rappahannock General, the one-floor hospital is bustling. Smith and Simonson arrive early for a day of back-to-back appointments with a dozen patients.

Connie Deagle is at the hub, arranging for examining rooms and briefing the Massey staff on the patients she has treated in the previous two weeks.

Today she must perform one of her saddest duties.

Tamara Tuttle, a 62-year-old widow from nearby Irvington, has suffered from breast cancer for the last year. Only one of her three adult daughters, Susie, who is mentally disabled, lives at home.

Susie is with her mother when Smith informs Tuttle that her breast cancer has spread so much that she probably will die within a year.

When Deagle enters the room at the end of the physician’s consultation, Tuttle begins to sob. As Deagle embraces her, she is more than a nurse. She is a neighbor and a friend.