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HIGH-quality cancer care can be delivered to patients in rural settings with the support of medical oncologists via teleoncology, according to Australian researchers.
A 5-year comparison study, published in the MJA this week, found no difference in the dose intensity and toxicity profiles for patients undergoing chemotherapy in the Townsville tertiary cancer centre, and those treated via teleoncology at the rural Mount Isa Hospital with supervision from a medical oncologist. (1)
Professor Sanchia Aranda, Cancer Council Australia CEO, welcomed the findings. She said the teleoncology model, developed by James Cook University’s Associate Professor Sabe Sabesan, had effectively removed the barriers to the delivery of chemotherapy in small communities and was helping to build the capacity of local health services.
“By upskilling local practitioners it leads them to be more likely to stay and work in those environments”, Professor Aranda said.
At Mount Isa Hospital, 89 patients received 626 cycles of various chemotherapy regimens, while at Townsville Cancer Centre 117 comparison patients received 799 cycles of chemotherapy.
Breast, colorectal and lung cancers were the most commonly treated cancers in the study, although most solid tumour types were treated at both centres, the researchers wrote.
They said the study was the first to show that many types of chemotherapy could be administered in rural centres using teleoncology without compromising safety and quality.
“These results, together with those of an earlier study that compared the safety of chemotherapy for rural and urban patients with breast or colon cancer, may reassure many urban clinicians that high-quality cancer care can be provided at rural centres by teleoncology models”, they wrote.
However, the researchers said strict governance and adequate resourcing was required for rural centres to effectively participate in such models.
Professor Aranda hoped that the study findings would encourage more urban-based specialists to support teleoncology in rural areas.
“The real challenge is that specialist clinicians are loath to move this way”, Professor Aranda said.
“Local communities are often quite keen to provide these services to meet the needs of their population, but it’s often the city specialists who are hesitant because they feel the responsibility. So knowing that it’s safe and there are mechanisms and guidance to be able to do it effectively is really important.”
Professor Aranda said the Queensland Government had been proactive in supporting the installation of telehealth in rural regions and the Queensland Remote Chemotherapy Supervision Guide (QReCS) provided a framework for other jurisdictions that wanted to provide teleoncology services. (2)
Dr Ewen McPhee, president of the Rural Doctors Association of Australia, said the study demonstrated that teleoncology was effective and provided good care to patients closer to their home.
“This makes it even more compelling that we should be pursuing telehealth aggressively”, he told MJA InSight, adding that it was important to continue to gather evidence on telehealth outcomes.
“The key thing is that teleoncology — and telehealth in general — should never be second best. If the outcomes using telehealth weren’t as good as the outcomes using a standard method of delivery and care, then we certainly wouldn’t want to force that on rural people”, said Dr McPhee, who uses telehealth in his practice in rural Queensland.
He said the provision of safe and effective cancer care in rural settings was “just fantastic” for patients, who lacked family support when they had to travel to larger centres for chemotherapy, and empowered rural doctors and nurses to operate to the full scope of their practice.
“[Rural doctors and nurses] really want to provide care and where specialists have the confidence and good communication with doctors on the ground, we know that those doctors can deliver those services. We could reduce transfers; we could reduce costs by having confidence in rural doctors to deliver the care that they are well trained to do”, he said.
Dr Craig Underhill, medical oncologist at Border Medical Oncology in Wodonga on the NSW-Victorian border, said teleoncology was a tool that could solve access problems for patients living in certain remote areas, but it was “not a panacea”.
He said teleoncology was time-consuming and would never provide the same level of care as was possible in face-to-face consultations.
“If patients are able to travel to regional centres for care, this is preferable. It allows patients access to the full gamut of services required”, Dr Underhill told MJA InSight.
“But if it’s a choice between no service and teleoncology, then teleoncology is a good option.”
(Photo: Monkey Business Images / shutterstock)
As a rural doctor on the other end of the videolink, providing teleoncology to our community two days a week, I applaud Dr Sabesan’s dedication, and would like to add – Yes, it most definately does work!
The effective delivery of treatment to patients in our facility is dependent on the support given by our three oncologists in the tertiary centre 1.5hours away. It also relies on the dedication of a core group of nursing staff in our facility who not only have the knowledge and skills to provide safe treatment, but also the “local knowledge” and connection with patients which extends beyond the bounds of their cancer care.
In response to Dr Underhill’s comments I would concur that teleoncology is not the same as face to face consultations. I also agree that we provide a different level of care to dedicated oncology services. However, I feel strongly that “different” is not necessarily inferior. I have witnessed the distress of patients when they are discharged from oncology services after successful treatment, or when treatment is no longer beneficial, without adequate support and effective links to services in thier local area. Through teleoncology, those links are embedded at the outset of treatment, assisting with the transition to care after oncology services are no longer involved.
Teleoncology is an invaluable tool in providing cancer care in rural areas. It does not replace face to face care, but complements the care that our tertiary centres are able to provide. The key to effective care still relies on good communication between all care providers, working together to provide the best possible care to our patients, regardless of their geographical location.