Health providers are more frequently using mobile clinics to provide services including dentistry and cancer screenings to far-flung patients in rural areas. Now researchers at Missouri University of Science and Technology in Rolla want to see if the mobile health care model could work for radiation cancer treatment, too.
A team of psychologists and systems engineers has used computer models and in-person interviews to weigh the possibility of using such units in rural Missouri.
Trucks with radiation treatment machines mounted on them already exist, said Alex Price, a systems engineering doctoral student who authored the feasibility study. But those trucks usually stay in the same place for months at a time.
“What we propose is taking it a step further and actually going fully mobile and not necessarily interim,” he said. “And that [way] we can treat in one location one week and try to be in another location the next week.”
Radiation machines — called linear accelerators or linacs — resemble massive Cuisinart stand mixers. They can cost millions of dollars, said Price, who works as a medical physicist. It’s important to study the feasibility of transporting one on the back of a semitrailer before spending money on a mobile system, he said.
“The hospital will not let me try to break a multiple-million-dollar machine, right?” Price said. “So it's kind of hard to know those limits, especially when we're at the point where we've never really needed to know what those limits are.”
Price put logistical and economic information into computer systems called a Monte Carlo simulation to model possible outcomes for a truck in rural Missouri and found it would work.
The second step of the process was interviewing patients and health workers to see if they would be willing to work with mobile cancer treatment, said Clair Kueny, a psychology professor at S&T and Price’s adviser on the project.
“The first phase was almost entirely systems engineering, and they did a simulation to determine how economical this type of mobile unit would be,” she said. “And now the second phase is trying to capture actual patients' and actual physicians’ perspectives of if this were reality.”
Patients and providers were concerned about the accuracy of a mobile unit compared with one that stays in a brick-and-mortar location, Kueny said.
“There’s absolutely a need in terms of rural cancer care,” she said. “Many, many patients in many, many counties in Missouri are driving well over an hour to receive oncology treatment.”
Mobile units are becoming more popular among rural patients as hospitals close and residents age, said Andy Grimm, CEO of the Northeast Missouri Health Council in Kirksville. The group of nonprofit health clinics uses a mobile dentist office to visit schools and provide services to kids who can’t easily make the trip to a traditional dentist office.
“It’s the stuff that’s targeting kids, the stuff that’s targeting elderly folks that are geographically isolated,” he said. “It’s so much easier to bring services to them than to bring them to the services.”
Grimm said community health clinics in particular have embraced mobile medical units. Because they’re federally supported, they’re charged with accepting all types of insurance, including Medicaid. They’re also more likely to offer preventative and primary care services, including screenings and immunizations, that are easier to provide in a truck than specialty care.
Mobile units for cancer treatment and other specialty care could be successful if patients were confident that the care they received was just as good as what they'd find at a hospital or outpatient clinic, he said.
Price , Kueny and other members of the S&T team will keep studying whether the mobile radiation unit could work in Missouri, Price said.
“The next step of this is to do a full, comprehensive simulation of this,” he said, “try to illustrate a Sim City within health care to kind of see the full extent and how this could function within Missouri.”
