So I happen to be one of those people that think time is important and where you are treated is important and I will tell you why. Time is important because the squamous tissue in your mouth replaces itself every 7-10 days. In order for cancer cells to grow faster than that they often will double in size every week or so. The bigger it gets the harder it is to remove or eliminate and the more impact it will have on your critical functions like swallowing, wetc. If I had your case at Stage IV and the local treatment facility was recommending Chemo only, I would start that treatment immediately AND start the process of getting into a regional cancer center. The chemo will likely have some impact on slowing the growth of the cancer while you get set up with a regional cancer center. My father and I both had the same type and subtype of cancer. He went to a local hospital and lasted 18 months after diagnosis. I went to a regional cancer center and have lasted 20 years so far despite having had 3 primary tumors. If the local hospital is recommending chemo and radiation siimultaneously then that would be a more difficult decision for me. I probably would still start the treatment and also try to get into the Regional Cancer Center. Best of luck.