Disparity in cancer survival between urban and rural patients--how can clinicians help reduce it?

Many reasons for the disparity in survival of 5-7% between rural and urban cancer patients relate to government policies and funding issues. However rural healthcare workers, particularly medical practitioners, can make an impact on reducing this disparity with attention to factors such as reducing referral processing time, using telemedicine, and ensuring ongoing education of rural patients regarding risk factors and screening programs, among other strategies

Tele Oncology for Cancer Care in Rural Australia

Rural cancer patients in Australia and other countries with significant rural populations face difficulties with accessing various sub specialist services mainly because of shortage of health care work force and long travel distances to access these services (Underhill et al, 2009). Partly as a result, their survival is lower than their urban counterparts (Campbell et al, 2001; Australian Institute of Health and Welfare, 2010; Sabesan and Piliouras, 2009). To improve equity of access and quality of life, clinics and treatment centres should be located closer to homes in rural towns. Currently, there are several models of care exist to address some of the issues as follows (Underhill et al, 2009): (1) medical oncologists travel to larger rural towns and chemotherapy is administered there. Frequency of these visits range between weekly to three monthly intervals; (2) patients travel to larger centres for consultation and return to their home towns to receive their chemotherapy; (3) patient’s travel to major towns to see the specialists and to receive chemotherapy. These models are often inadequate, expensive and cause problems for patients, specialists as well as rural doctors who would ultimately care for these patients

Access to Clinical Trials Closer to Home Using Tele-health

The purpose of this chapter is to outline key considerations for increasing access to clinical trials for people with cancer living in rural and remote locations, and outline the contribution of tele-health models to facilitate study activity across rural and remote locations. Regional and rural group of the Clinical Oncology Society of Australia (COSA), the peak multidisciplinary cancer clinician body in Australia, has developed the Australasian Teletrial Model in collaboration with its stakeholders to improve rural access to clinical trials. Benefits of this model are not limited to regional, rural and remote systems. This model has the potential to connect larger centres even within the same city and improve the rate of recruitment of highly specialised clinical trials, including rare cancer trials. This model has been developed in consideration of the requirements for the proper conduct of clinical trials ensuring the protection of the rights and safety of trial participants and quality data for the demonstration of safe and efficacious cancer treatments. Ethical and safe conduct of clinical trials using this model requires that the following aspects are considered and addressed by implementation plans

Telemedicine platforms must be leveraged to strengthen rural health systems

[Extract] Telemedicine is a technology that has come of age, now it must be put to use to address inequities in cancer care. The principles and applications of telemedicine have undergone rapid evolution over the last two years globally.1, 2 Prior to the COVID-19 pandemic, the utilisation of telemedicine was largely driven by local champions and lacked systematic uptake despite Government investment and incentives at both state and commonwealth levels. The pandemic and the resulting need for social distancing saw rapid and widespread adoption of telephone and telehealth services aided by Government funding, even for patients in metropolitan areas. Now is the time to leverage this momentum to embed telemedicine in our health systems

Optimal care pathways for people with lung cancer - a scoping review of the literature

Introduction Much of the existing work around implementation of cancer optimal care pathways (OCP) has either focused exclusively on the clinical elements of care or has targeted individual stages in the cancer trajectory, rather than using a patient-centred or service delivery lens to inform the integration of care across the continuum. This review aimed to identify and summarise the available literature on lung cancer OCP. Methods A scoping review was conducted, with literature across multiple databases and grey literature searched. Articles were included if the OCP was being used to manage adult patients with lung cancer and reported on either the development process and outcomes and/or barriers and facilitators associated with optimal care pathway development and/or uptake. Results Of the 381 references screened, 32 articles were included. The lung cancer pathways reviewed varied significantly. A number of themes were identified including the development and implementation of the OCP; the use of quality indicators to audit the OCP; and studies on outcomes of the OCP incorporating timeliness of care delivery, patient experiences and health care utilisation and costs. Conclusions The limited number of relevant articles found in this review may suggest that an OCP for lung cancer is still in its preliminary stages across the broader health systems

Patient and carer experiences of lung cancer referral pathway in a regional health service: a qualitative study

Background: Lung cancer referral pathways aim to reduce delays and improve referral patterns of people with suspected lung cancer. Aim: As part of implementing a lung cancer referral pathway at a regional Australian hospital, this study aimed to explore the experiences and perceptions of people with lung cancer and their carers. Methods: In-depth interviews were used to elicit data for thematic analysis in this cross-sectional descriptive qualitative study. Patients with newly diagnosed lung cancer and their carers at a regional academic cancer centre were invited to participate in interviews. Five interviews were conducted face-to-face, and 14 interviews were conducted by telephone (as per interviewee preference). Interviews were audiorecorded, transcribed and qualitatively analysed. Descriptive phrases were used to generate initial inductive codes and themes. Results: Nineteen participants approached agreed to take part in the study. Factors that positively impacted the care experience were good communication, timeliness and patient advocacy and support. Improper communication, long waiting times for investigations and appointments, uncertainty about the process and inconsistent advice from providers negatively impacted the care experience. Participants preferred face-to-face or video-linked consultations over telephone consultations. Conclusions: Understanding the experiences of rural and regional patients and carers with the lung cancer referral pathway is important to improve quality of care. Implementing changes to the referral pathway to improve patient and carer experiences needs to be an ongoing quality improvement exercise

Perspectives of Complementary and Alternative Medicine use by cancer patients in a regional hospital in North Queensland, Australia

Objectives: This study aimed to investigate CAMs used, and reasons for and disclosure of this use by cancer patients in a regional hospital in North Queensland, Australia. Methods: Patients attending the Day Oncology Unit of the Townsville University Hospital were invited to participate in a self-completed questionnaire or telephone interview regarding perspectives of their CAM use. Data were analysed using descriptive statistics and chi-squared and independent t-tests were performed to allow comparison between the responses by CAM users and non-users. Results: 102 completed questionnaires were used in the analysis, where 40.2 % of respondents were found to be using some form of CAM. Cannabis, magnesium, and massage were the most prominent therapies used, with cannabis use in cancer, not commonly reported in prior literature. The main reasons given for using CAM were to treat symptoms of cancer, side-effects of treatment or to improve general health. Two-thirds of these respondents disclosed their CAM use to health professionals mostly to obtain a professional opinion or due to concerns of interactions with cancer treatment. CAM users were statistically more likely to have used CAM prior to their cancer diagnosis and have lower emotional wellbeing than non-users. Non-CAM users indicated that a lack of knowledge of CAM or concerns regarding interactions with cancer treatment were the most popular reasons for not adopting these therapies. Conclusion: While lower than the averages of previously published CAM use, our study highlights that there is still a significant group of cancer patients in the North Queensland region using CAMs

Knowledge, attitudes, and practices of Australian oncology health professionals on complementary medicines

Background: Approximately half of people with cancer are using complementary and alternative medicine (CAM), presenting safety concerns due to potential interactions with conventional cancer treatment. Oncology staff have a role to play in ensuring the safe use of CAMs and so, this study examined their knowledge, attitudes, and practices regarding CAMs. Aim: This study aimed to assess the knowledge, attitudes, and practices of Australian doctors, nurses, and pharmacists regarding CAM use in oncology. Method: Members of three national oncology professional associations took part in an online questionnaire, which determined their knowledge, attitudes, and practices regarding CAM. Results: Ninety-nine completed surveys were obtained from nine doctors, 70 nurses, and 20 pharmacists. Most respondents (68.4%) felt that they did not have adequate knowledge of CAMs to respond to patients' questions. Assessment of attitudes found respondents generally believed that CAMs have a complementary role in oncology but indicated their concerns for the safety of patients. Respondents indicated in practice they would discuss CAMs with less than half of patients (40.6%), with a lack of scientific data and guidelines for CAM use presenting significant barriers to these discussions. Conclusion: Our study suggests that oncology health professionals' knowledge of CAMs potentially leads to a lack of confidence in providing advice to patients and concerns for patient safety. This impacts their discussion of CAMs and lack of disclosure from patients about their use of CAMs. Education on CAMs in oncology would assist in increasing professionals' confidence in discussing these therapies, leading to increased patient disclosure of CAMs and safer treatment decision making for people with cancer

Use of telehealth in the management of non/critical emergencies in rural or remote emergency departments: a systematic review

Background: Telehealth has been used extensively in Emergency Departments to improve healthcare provision. However, its impact on the management of non-critical emergency presentations within rural and remote ED settings has not been adequately explored. The objective of this systematic review is to identify how telehealth has been used to assist in the management of non-critical presentations in rural and remote emergency departments and the outcomes. Methods: Articles were identified through database searches of CINAHL, Cochrane, MEDLINE(OVID), Informit and SCOPUS, as well as screening of relevant article reference and citation lists. To determine how telehealth can assist in the management of non-critical emergencies. Information was extracted relating to telehealth program model, the scope of service and participating health professionals. The outcomes of telehealth programs were determined by analysing the uptake and usage of telehealth, the impact on altering diagnosis or management plan as well as patient disposition including patient transfer, discharge, local hospital admission and rates of discharge against medical advice. Results: Of the 2532 identified records, fifteen were found to match the eligibility criteria and were included in the review. Uptake and usage increased for telehealth programs predominantly utilised by nursing staff with limited local medical support. Tele-consultation conservatively altered patient diagnosis or management in 18-66% of consultations. Although teleconsultation was associated with increased patient transfer rates, unnecessary transfers were reduced. Simultaneously, an increase in local hospital admission was noted and less patients were discharged home. Discharge against medical advice rates were low at 0.92-1.1%. Conclusion: The most widely implemented hub-and-spoke telehealth model could be incorporated into existing referral frameworks. Telehealth programs may assist in reducing unnecessary patient transfer and secondary overtriage, while increasing the capacity of ED staff to diagnose and manage patients locally, which may translate into increased local hospital admission and reduced discharge rates following teleconsultation