Car-A-Van Keeps Cancer Patients On the Road

Free Van Services Helps Cancer Patients Go From The Big Horn Basin to Cody for Treatment

By Bob Vines
For The Wyoming Medical Society

CODY — Kevin Johnson has every available restroom along a 425-mile route through Wyoming’s Big Horn Basin flagged in the GPS system of the white Honda minivan affectionately known as the Care-A-Van.

“So I can tell them exactly how many miles and how many minutes it’s going to take to get there. It’s for my own benefit too,” he said with a laugh.

It is a job requirement, especially when treating patients undergoing the not-so-pleasant inexact science of proper bladder fullness in order to receive radiation treatment for prostate cancer.

Twice a week, Johnson leaves the parking lot of Big Horn Basin Radiology Center in Cody before the sun rises. He picks up his first passengers in Thermopolis at 6:30 a.m. and turns north, stopping in Worland, Basin and Greybull before heading back to the clinic. Once each passenger meets their appointment, Johnson loads them back up and takes them home.

“I have learned a lot about everything from beekeeping to how to raise the right amount of grass in the right spots,” he says. “It becomes real personal real quick in a small vehicle, and everybody has a good time. It’s usually pretty lively. It gets hard to concentrate on driving sometimes because I’m laughing so hard.”

Although Johnson only makes this trip on Thursdays and Fridays (he has a partner that drives the other three days of the work week), the passengers make this trip five days a week for up to nine weeks. By noon, they are back to their respective daily routines after receiving radiation treatment for a wide range of cancers.

One of those passengers, Marcus Arthun, 71, operates a small ranch south of Worland and is preparing for calving season, which will begin before he receives his final radiation treatment for prostate cancer. He has completed 15 of 45 treatments and admits his energy level is affected by the radiation, but it doesn’t slow him down.

“I’m better off going (rather than not getting treatment),” he says. “I have to keep doing stuff.”

Arthun was apprehensive when he first learned that his treatment plan would require daily radiation treatments in Cody. But the Care-A-Van not only allows him to continue his ranching operation, it also allows him time with others who understand what he is going through. And in the case of his chauffeurs, he gains insight from survivors since both Care-A-Van drivers have beaten their own cancers.

“They have compassion for it,” Arthun says. “They share their frustrations and experiences. All that helps. No question.”

“I was lucky with my cancer,” says Johnson, whose colon cancer was resolved through surgery. “The shock of being told you have cancer for the first time hits you like a truck. But I must live a charmed life because I never had to go through what they are going through. I’m learning every day what it’s like to go through what they’re going through, and I feel so fortunate.”

With the closest treatment center an hour and a half away for patients like Arthun, just getting there can be a challenge. This is where the Care-A-Van comes in. The free service, which is funded through St. Vincent Healthcare and private donations, is necessary for rural patients to receive treatment with as little intrusion into their lives as possible.

As St. Vincent Healthcare Director of Satellite Operations Kendra Eaton says, it isn’t financially feasible to provide such care any other way.

“It takes many resources and a relatively high patient volume to be able to support high quality care in a small community. For example, radiation oncology programs are typically only present in communities that have a population of 100,000 or greater,” she said.

That is more than ten times greater than Cody’s current population. The entire Big Horn Basin’s population is less than 50,000.

Big Horn Basin Radiation Center radiologist Dr. Michael Smith says, “The actual (radiology) machine costs $3 to $5 million, then you have to have a vault with 8-10 feet of concrete walls with the rest of the clinic. When all is said and done, to build a radiation center is anywhere from $10 to $15 million.”

He says the clinic treats around ten patients daily, although that fluctuates considerably at times.

Smith credits the transportation program with making difficult decisions easier for cancer patients.

“I think without the van, there are a fair number of people that would not be treated because logistics would be impossible,” he says. “Transportation issues are huge – getting people to and from appointments. Especially with radiation where we have six to eight weeks Monday through Friday – that can be daunting for someone who lives an hour-plus from a treatment center. A lot of these people are elderly and could be facing some real grim choices.”

Smith uses breast cancer patients as an example. There are typically two paths of treatment – mastectomy or lumpectomy. With a lumpectomy, the patient has the tumor removed followed by a sampling of the lymph nodes then six and a half weeks of radiation. He said that some doctors report that many patients choose the mastectomy over the lumpectomy simply because a lot of the women logistically can’t do the follow-up radiation treatment.

“You might have an older lady who cannot drive well. If she has breast cancer she might be forced to do a mastectomy rather than keeping her breast simply because transportation is an issue,” he says. “But if they have the van to ride then it’s a different story.”

The Care-A-Van has operated out of the same parking lot since before the clinic’s construction. The current location used to be a parking lot for West Park Hospital. Patients would meet there to be transported to a cancer center in Billings, Mont. That was 18 years ago when dosimetrist Blake Smith first began working for the clinic.

Blake Smith says the Care-A-Van program has gone through some changes over the years, but the idea remains the same.

“Our treatment deliveries have changed but as far as transportation, that doesn’t change much, although it is much more comfortable (these days),” Smith says.

Previous buses were big and clunky, with turned odometers and finicky temperature controls. That issue has been resolved with yearly leases. The new Care-A-Van may lack certain personality; however, its drivers and passengers appreciate the sleek style and technologies such as GPS.

After receiving his fifteenth treatment, Arthun was back at the ranch in the early afternoon just in time to move hay.

“It is better than I thought it would be,” he says. “When I first heard (I had cancer) – well, nobody wants to face up to it. I knew I was going to go ahead and do it (traveling to receive treatment), but I anticipated it to be more difficult than it is. It has been a positive experience.”