No-one will be left behind in Australia’s first national cancer plan. How to have your say on the draft.
Equity and patient-centred care are the focus of the much-anticipated Australian Cancer Plan draft, released this week for public comment.
Australia has had many individual plans across states, jurisdictions and cancer types, but this is the first time there has been a national approach across the continuum of care.
Developed by Cancer Australia, it covers six objectives – prevention and detection, patient experience, systems, infrastructure, workforce, and equity – and outlines 10-year ambitions with actions, two-year and five-year goals.
The Government calls it a “a ground-breaking national strategy” that sets out to create “coordinated system-wide engagement.”
So, what will you find in the 165-page draft document?
While a detailed implementation plan is to be developed over coming months, the draft provides a clear picture of cancer in Australia and a framework for getting where we want to be over the next decade.
Australia’s cancer statistics compare well globally, but below the headline numbers there is an uncomfortable disparity.
Federal Health Minister launched the draft Australian Cancer Plan (ACP) on Thursday morning and said equity was a strong focus.
“Cancer incidence and survival outcomes are not evenly spread across the population,” he said.
“A key component of the plan is achieving equity in cancer outcomes, particularly for Aboriginal and Torres Strait Islander people.”
Latest figures show mortality rates have gone down for non-Indigenous Australians by 16% and increased by 26% for Aboriginal and Torres Strait Islander People.
Most cancer types have seen improved survival rates due to screening and better early detection and treatment. However a few – renal pelvis, bladder, and eye cancer – have gone the other way. Evidence shows that cancer risk, experience and survival are strongly associated with social and cultural determinants of health and can also depend on postcode and personal circumstances.
“Consumer needs” are front and centre in the plan, with groups that currently have less access and greater need identified and prioritised.
These include Aboriginal and Torres Strait Islander people, the lesbian, gay, bisexual, transgender, intersex, queer, and asexual (LGBTIQA+) community, people from culturally and linguistically diverse (CALD) backgrounds, people living with disability, people living in low socioeconomic areas, people living with a mental illness, older Australians, adolescents and young adults, children, and people in rural and remote areas.
The plan links to existing strategies, frameworks, plans, guidelines and pathways that support these groups.
It also outlines new actions required, such as creating community-led partnerships, workforce training, data linkages, improving health literacy, supporting active involvement, addressing affordability, strengthening policy and regulation, increasing telehealth, recognition of family and carers, developing consumer navigation models, improving national data sets, enhancing research, expanding access to risk-modified screening, improving access to new treatments, enabling personalised medicine, developing digital health, and building capability in the primary care workforce.
The document highlights the need for strong collaboration in order to effectively share responsibility for cancer care across governments, regulators, health services, Aboriginal and Torres Strait Islander leaders and communities, non-government organisations, clinicians, researchers, professional colleges, the private health sector and consumers.
The authors noted that the final version of the plan will include more on covid, climate change and international engagement, as well as a framework for evaluation.
Just hours after Mr Butler launched the draft plan, Cancer Australia CEO Professor Keefe hosted a panel discussion on the strategy at the 2022 Clinical Oncology Society of Australia’s Annual Scientific Meeting in Brisbane.
“One of the really important things about the plan is that people can see themselves in it, that it resonates with everybody because it’s tumour agnostic,” Professor Keefe told delegates.
“I don’t want you to feel that you’re not included in this plan.
“We’re all in this together. Although this is a Commonwealth cancer plan, there is room for everyone to join in the implementation.”
Prevention and detection
The first strategic objective of maximising cancer prevention and early detection focuses on eliminating racism and discrimination as barriers and supporting the reduction of modifiable cancer risks (such as smoking and obesity) through policy and regulation.
It also aims to increase national screening and immunisation program participation by providing culturally safe ways for priority groups to engage, introducing new and targeted risk-stratified screening programs and creating policy and adopting new technologies to assess genomic risk.
At two years, “culturally safe prevention and screening approaches” should be improved and personalised prevention and early detection strategies identified.
At five years, both should be standard practice, according to the draft plan.
System-wide barriers to early detection and prevention, especially social, cultural and commercial determinants of health, are to be identified and addressed.
Enhanced consumer experience
This objective is “central to the health system”, according to the plan.
“There’s no point in curing the cancer if you make life really, really miserable,” said Professor Keefe.
“Someone said to me yesterday, that it’s only half a life. And I think that’s a really powerful line. ‘Do I have to stay on this therapy forever? Because yes, I’m alive and yes, I love it. But it’s only half a life.’ We have to do something about that.”
The plan emphasises co-design and partnerships between patients, their support systems and care providers, enabling decision making, navigation of the health system, communication and addressing functional, psychological, spiritual and social aspects of care, as well as physical, all of which spans the continuum of care across the entire period of cancer experience and takes into account cultural, linguistic, and socioeconomic circumstances.
This will involve “re-orientation of the existing workforce”, training a workforce to prepare for personalised care models and adopting strategies to fairly distribute that workforce.
Professor Keefe provided an example of how the Australian Cancer Plan could make a difference in everyday provision of care.
“Say you’ve got an oncologist in a busy hospital consulting with a patient,” she said.
“In two years’ time we’ve got a piloted multichannel, multidisciplinary navigation model that gives the patient and the family access to the right type of navigation that they need at the time.
“If you can manage with the app, you manage with the app. You can go online and get the information. But at any point you can press the escape button and get to the next level of personal interaction, so the Cancer Council helpline, and escalate again if necessary to a nurse who can deal with your particular issues.”
The optimal care pathways (OCPs) will have a national framework by five years that is integrated as part of routine cancer care.
And there’s clear linkage from implementation of the OCPs to change patient outcome and experience. If you link an OCP with good navigation and measure the data, you will be able to show the advances that we’ve had.’
World class health systems for optimal care
Systems need to be coordinated, integrated, data-driven and consistently high quality, says the plan, and elements of this exist, but not for everyone. The objective is to change that by getting all involved services and health professionals to work together better and to collect and share their data, including patient reported experience and outcomes.
This will ensure everybody is getting the same up-to-date care and will show when and where that’s not happening. A system of governance will be set up to enable this across jurisdictions.
A National Comprehensive Cancer Centre Network (NCCCN) will monitor performance, and national frameworks will standardise Optimal Care Pathways and create a network of comprehensive cancer care, including a role for comprehensive cancer centres.
The plan requires action to improve access to “evidence-based, innovative models of integrated multidisciplinary care” and “accepted, traditional healing practitioners within cancer services to enable an integrated, trauma-informed oncology approach for Aboriginal and Torres Strait Islander consumers.” Data is to be collected on Indigenous status (with consent) on all pathology requests.
Palliative and end of life care models are also addressed in this goal, as are models for living with and beyond cancer.
Strong and dynamic foundations
This objective is all about infrastructure, technology, research and data. The plan addresses the need for research funding, inclusive trial participation, and the ability to collect and access data to drive better outcomes.
To this end, a national cancer data ecosystem is proposed which will encompass national frameworks for collecting data from all providers, including patient reported experience and outcomes.
The data will be used to assess services for all population groups and establish an evidence base and will be incorporated into national performance monitoring, with regard to Indigenous Data Sovereignty.
Data is also meant to facilitate “targeted and innovative research investment into areas of unmet and emerging need; and improve clinical trial design and equitable access”. Digital and virtual care is to be expanded.
Workforce to transform the delivery of cancer care
The plan says: “All Australians will have access to a supported, engaged, and well-equipped cancer care workforce that delivers optimal cancer care for people affected by cancer”.
“The ability to progressively transform the workforce is also critical to the successful achievement of the 10-year ambitions of the other five ACP Strategic Objectives,” it says.
The plan is to identify undersupply and implement a workforce “pipeline” that reflects the diversity of patient populations, enhance existing capability in primary care, support practitioners to practice at the top of their scope, provide access to professional development, integrate cultural safety training and nationally coordinate recruitment, training and retention of an Indigenous cancer care workforce.
Achieving equity in cancer outcomes for Aboriginal and Torres Strait Islander People
“A core issue within the ACP is the critical need to address individual and institutional racism and discrimination experienced by Aboriginal and Torres Strait Islander people across the health system,” the plan says.
Cancer services and practitioners will be held accountable for providing a culturally appropriate and safe cancer care system, free from racism and discrimination.
“We have unashamedly focused mostly on achieving equity and cancer outcomes for Aboriginal and Torres Strait Islander people because of the ongoing effects of colonisation,” said Professor Keefe.
The knowledge of Indigenous people is to be valued and Indigenous people will be provided with career pathways to training as healthcare providers.
Aboriginal and Torres Strait Islander people will be involved in policy development for cancer prevention, standards and care delivery. Partnerships with communities and organisations will be established or enhanced where they already exist, as well as “place-based engagement”.
This objective is both big-picture and ground-level, with the draft document unequivocally stating, “Individual and institutional racism and discrimination will be called out and addressed”.
How to have your say
The National Cancer Plan draft is open for comment until 16 December 2022 and will be presented to the Minister in April 2023.
For an insight into some early feedback on the draft, see the following story in this special edition of the Oncology Republic newsletter.