The draft cancer plan is a big document with big ambitions, and experts say there will be challenges.
The right carrots and sticks will be vital to the success of the national cancer plan, according to experts who have seen Cancer Australia’s draft strategy.
Professor Dorothy Keefe, Cancer Australia CEO, told delegates at the Clinical Oncology Society of Australia’s Annual Scientific Meeting in Brisbane yesterday that the newly launched draft plan was consultative, focused on the future, strength-based and “tumour agnostic”.
.@CEOCancerAus Dorothy Keefe and expert panel @COSAoncology @garvey_gail @MichaelKidd5 @thefortrans, Tania Rishniw and Deborah Henderson discuss the draft #AustralianCancerPlan and public consultation at #COSA2022 pic.twitter.com/B1PidXeD6G— Cancer Australia (@CancerAustralia) November 3, 2022
This will be Australia’s first nationally coordinated approach to cancer and is focussed on providing equity of care.
“We have some of the best cancer outcomes in the world, but that is not uniform across the country or across different population groups,” said Professor Keefe.
This fragmentation of care and health systems were one of the biggest roadblocks identified by Professor Keefe’s fellow panellists, and audience members who commented on the draft strategy.
Co-panellist radiation oncologist Associate Professor Dion Forstner warned that its implementation would face “huge challenges”, singling out the different governance across states and territories.
“I do envy my New Zealand colleagues,” he told the audience. “But we have got some things that can be controlled at a Commonwealth level.”
“I make myself unpopular, talking about the carrot and the stick. But in fact, doctors are very conservative in changing their practice.”
To make these changes, appropriate incentives will need to be developed, he said.
“[But] we have systems like Medicare that can do that.”
Objectives related to workforce supply would also prove challenging, said Professor Forstner, especially with an ageing population.
Education funding was also a complex issue, he said, noting that cooperation was needed between the private and public health sector.
Deputy chief medical officer Professor Michael Kidd, who is leading Australia’s national primary care response to covid, said lessons were learned from the pandemic about the importance of improving data linkage and data use.
“Some of our systems, especially sharing between jurisdictions, have become a lot stronger over the last couple of years and I think the plan will benefit from that,” he said.
He welcomed the plan for being dynamic to future changes, and the clear input from current research and advocacy it incorporated.
Australian Cancer Plan: a catalyst to improve access to equitable, safe, quality, coordinated care. I’m excited for the opportunities the ACP brings to improve collaboration & equitable access to optimal cancer care & improved outcomes for ALL patients #COSA22 @melanomasupport pic.twitter.com/uN3sFBF3ZB— Claire Kelly (@cancercarenurse) November 3, 2022
Ms Tania Rishniw, who was involved in negotiating the national mental health and suicide prevention agreement on behalf of the Department of Health, had a more optimistic view of the fragmentation of systems in the nation.
The “competitive tensions” between state and federal jurisdictions provided “opportunity for innovation with different jurisdictions doing things differently,” she said.
“If we’ve been able to come together nationally through the last three years around covid, it sets a great pathway for us to do that around cancer,” said Ms Rishniw.
The place of comprehensive cancer centres, criticised as being hospital and metro centric and not really comprehensive, was also questioned.
Dr Keefe said the plan incorporated the centres into a network, both with other centres and with patients.
“The idea is that you have an optimal care pathway for a patient, surrounded by a network of cancer care that provides cancer treatment as close to home as safely possible,” she said.
“But without the navigation and the integration, we haven’t got the ability to do that communication.”
Ms Deborah Henderson, a 10-year survivor of chronic lymphocytic leukaemia and co-author of the Optimal Care Pathway, praised the plan’s ambitious goals, and hoped it would lead to more consistent care.
“I couldn’t believe there wasn’t a common pathway for patients to navigate, but most importantly for their clinicians,” Ms Henderson told delegates.
Two people with the same markers seeing different physicians would get different treatment, and might not even get precision testing, she said.
Putting the pathways into the hands of patients would help achieve equity and encourage accountability, said Ms Henderson.
“So, we talk about carrot, but I think there will end up having to be sticks because it is not right that people don’t follow existing guidelines if they are proven to lead to better treatment and long term outcomes,” she said.
In fact, the gap between outcomes for Indigenous people and non-Indigenous people was growing, said Professor Gail Garvey, a Kamilaroi woman and researcher from the University of Queensland.
She said the plan was an opportunity to make a significant difference to cancer outcomes for Aboriginal and Torres Strait Islander people.
“Eliminating racism is really at the core of the issues,” Professor Garvey said.
“Before we can start to look more specifically at services and other aspects of the cancer journey, we need to change the culture of the system. We can’t do that unless we have strategies and we put racism right at the front and begin to address that.
“All of our hope is in the Australian cancer plan and everyone in this audience so that we can make a difference.”
Excited that the Australian Cancer Plan #ACP recognises the needs of older people with cancer! But firstly puts patients at the centre. PATIENT-CENTRED. Equity-focused. Future-focused. Strengths-based. Evidence-informed. Tumour agnostic. Whole continuum. Collaborative. #COSA22 https://t.co/if0U7hA3Mp pic.twitter.com/G76wXuEs1i— Kheng Soo (@KhengSoo1) November 3, 2022
She noted that in Australia there were no Indigenous oncologists, about 400 Indigenous doctors, three surgeons, and fewer than five cancer care nurses.
There were Aboriginal and Torres Strait Islander liaison officers in every public hospital working across all diseases, while Townsville was in the enviable, unusual position of having an Aboriginal liaison officer working in the cancer care team.
“I think we can make a massive difference if we just change that workforce scenario and have Aboriginal and Torres Strait Islander people working in cancer services and in cancer care; we can do that through patient navigation,” said Professor Garvey.
“This is something where, through some specific dedicated funding and resourcing, we can immediately make a difference to cancer outcomes for Aboriginal and Torres Strait Islander people.”
Many people in the audience wanted to know how the plan’s “lofty goals would trickle down to cash strapped health services, which are currently not capable of providing optimal care due to staffing and funding.”
Professor Forstner said that collecting data on outcomes would highlight where they were falling short and allow the spotlight to be shone there.
“If it’s on the front page of the paper, instead of ambulance ramping it’s going to be much better and it’s going to result in change,” he said.
Consultation on this draft of the Australian Cancer Plan is open until 16 December 2022. The final document is expected to be provided to the Department in April 2023.