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DESPITE evidence confirming the regional and remote disadvantage in cancer outcomes, leading Australian experts remain optimistic that progress is being made.
Research in the MJA showed 8878 excess cancer deaths in regional and remote areas between 2001 and 2010. For men, the age-standardised mortality ratios compared with metropolitan areas showed no evidence of improvement (1.08 in 1997–2000 vs 1.11 in 2006–2010), while in women it worsened (1.01 vs 1.07). (1)
“The regional and remote disadvantage for cancer deaths has been recognised as a problem for more than two decades, yet we have made little progress”, the MJA authors wrote.
“This is not surprising — we have not invested in research into solutions.”
Dr Darshit Thaker, a medical oncologist based at Royal Brisbane and Women’s Hospital (RBWH) who services the Hervey Bay area on Queensland’s central coast, disagreed with the researchers’ pessimistic conclusion.
Cancer health service provision in rural and remote areas “is a very complex issue”, Dr Thaker told MJA InSight.
“It starts with screening and diagnosis, and moves through treatment and monitoring. There are resource issues, workforce issues, social issues and travel issues.
“But we have made progress. The workforce is improving, and telehealth is improving, if not yet optimal.”
Dr Thaker is one of several oncologists from RBWH who provide fly-in fly-out [FIFO] services to rural and regional areas in Queensland in combination with telehealth clinic services at the hospital.
“It’s a classic example of integrating health services in order to try to bring the same standard of care to rural and remote areas as is available in the cities”, he said.
“That’s where the progress is. Integration needs to be increased.”
One area Dr Thaker pinpointed for urgent attention was Indigenous cancer care.
“Whatever we can provide for Aboriginal and Torres Strait Islander patients closer to home is more desirable”, he said. “…when they are far from home they feel lost and are less likely to be compliant with treatment.
“If we can provide [services] closer to home, at least they will be receiving care.”
Professor Ian Olver, chief executive officer of Cancer Council Australia, was also optimistic about the chances of reducing regional disadvantage.
“I’m not as despondent about the situation”, he told MJA InSight.
“The authors are suggesting we research solutions. There are viable solutions out there, like fly-in fly-out multidisciplinary teams and regional cancer centres.
“The $556 million that was allocated in the 2009–2010 Budget to regional cancer centres from the Health and Hospitals Fund — that’s huge and a pretty good start.
“We have to evaluate the impact of that, but it’s still very exciting.”
Professor Olver said approaches like the telehealth clinics run by Dr Thaker and Dr Ewen McPhee in Emerald in central Queensland, and FIFO teams like the one servicing Cunnamulla from Brisbane, run by Dr Noel Hayman and Dr William Wang, were proving that progress was being made. (2), (3)
“All these models exist but a more coordinated approach would make things better”, Professor Olver said.
The MJA authors concluded that more research to “guide service planning and budget decisions” was not prestigious but urgently needed “if all of the Australian community are to benefit from laboratory and clinical advances”.
1. MJA 2013; 199: 605-608
2. MJA 2013; 198: C1-C2
3. MJA 2013; 199: C1-C2