PROSTATE cancer is the second most common cause of male cancer-related mortality in Australia. In fact, more men die from prostate cancer in Australia each year than women die from breast cancer.
What complicates prostate cancers is that many will not be clinically significant, so there is a need to minimise the risk of overdiagnosis and overtreatment in these cases, but at the same time improve the diagnosis and treatment of the more aggressive cancers.
Most capital cities have private facilities to surgically treat prostate cancer, including robotic-assisted radical prostatectomy, which is becoming increasingly available in some public hospitals.
Robotic surgery is expensive. Hospitals have to spend large amounts of money to buy the instrumentation, which often come with high-cost servicing contracts.
One reason for the high cost to the patient is consumables — the throwaway items associated with the technology. Private health funds are not obliged to cover the costs of consumables, which can leave patients with out-of-pocket costs of up to $4000.
The other reason for huge out-of-pocket expenses is that, in some instances, the surgical gap payments above Medicare and private health fund rebates can be more than $10 000.
On the basis of consumables and surgeon’s fees, the cost of robotic-assisted radical prostatectomy in the private system can be substantial.
So it was probably only a matter of time before there were crowdfunding campaigns to raise money to pay for expensive prostate cancer surgery.
Crowdfunding campaigns for donations to pay for surgery have always made me sad. Neurosurgery, in particular, seems to be a reason for crowdfunding, but I had hoped that this would never be necessary in my specialty.
However, I recently saw a crowdfunding campaign through social media for a young man who needed robotic radical prostatectomy “ASAP” and was unable to meet the costs of treatment.
I was moved by this man’s story, and it prompted me to try to help him in some way. I resorted to social media to advocate against crowdfunding for access to prostate cancer surgery.
This resulted in offers to the crowdfunding website from two experienced and respected surgeons to carry out the surgery for free. The response was: “Thank you for your message, it is very much appreciated. We have already committed with the surgeon, Dr xxxx at xxxx, who has handled [the patient’s] case from day 1”.
While the doctor–patient relationship is special, with some patients going to great lengths to maintain it, this response raises a number of concerns. Has the patient discussed his problems with meeting the costs of surgery with his surgeon? If the patient cannot afford the cost of surgery in the private sector, why aren’t there options in the public sector to provide equivalent quality of care?
I would not be able to sleep if I knew that a patient of mine had to beg for public sympathy and crowdfunding to pay for my services, and it seems likely in this case that the surgeon is not aware of the patient’s crowdfunding activities.
Radical prostatectomy has changed significantly in the past 20 years — from a high blood loss, long hospital stay and primarily extirpative procedure to one that combines sound oncological principles and maximises functional preservation. It is increasingly viewed as a subspecialty.
Recent research shows robotic prostatectomy can offer improved outcomes and reduce costs. It is currently offered in high-volume prostate cancer centres at public hospitals in Brisbane, Sydney and Melbourne.
In the public system, audits demonstrate surgery outcomes for individual hospitals that, in most cases, show patients should expect first class cancer care.
Just as patients can identify which private doctor or hospital they prefer for their care, they can also readily identify which public hospitals are offering high-volume prostate cancer surgical services.
The prospect of a long waiting time for prostate cancer surgery in a public hospital can encourage patients to seek private care. However, prostate cancer is relatively slow growing and the vast majority of patients can safely take the usual 90-day wait after a request for admission for public hospital surgery.
Crowdfunding for this treatment should not be necessary in Australia. Do we, as a profession, need to better understand the financial, as well as health, impacts on our patients when we advise on treatments and procedures for life-threatening conditions?
Professor Henry Woo is an associate professor of surgery at the University of Sydney. On Twitter @DrHWoo