A medical oncologist shares his insight into how equitable cancer care can be delivered from the clinic.
Equitable cancer treatment for all is a priority of the newly released Australian Cancer Plan draft, but implementation won’t happen overnight, experts say.
However there are some actions that can be taken to see immediate change, Dr Abhijit Pal told delegates at the Clinical Oncology Society of Australia’s Annual Scientific Meeting in Brisbane earlier this month.
“There’s a framework here where we can all think about these issues together and act to do this,” said Dr Pal, a medical oncologist who practises in south-west Sydney.
“The question, in my mind at least, is how are we going to get there?
“The cancer plan and these goals are very clear, and we all agree on them. But what do the concrete nuts and bolts look like on how you achieve these goals in our day-to-day practice?”
Dr Pal sees many patients from culturally and linguistically diverse backgrounds. Having previously worked in central Australia and regional NSW, he is also familiar with the healthcare issues faced by patients from rural areas and of lower socioeconomic status.
He observes persistent inequities in outcomes and key performance indicators, including time to diagnosis and access to screening, treatment and clinical trials.
“The south-west Sydney population experiences greater challenges on basically every demographic indicator,” Dr Pal said.
“This includes high socioeconomic disadvantage, unemployment, low levels of English proficiency, high rates of humanitarian settlement, high rates of disability and the need for assistance, high birth rates, and rates of lifestyle diseases.
“These factors make it more difficult and costly for the healthcare system to meet ongoing community needs.”
He gave delegates at the conference three specific examples of actions that can be taken to head off inequity.
1. Data is everything
Improving access to oncology services for diverse populations ultimately requires measuring, intervening and re-measuring, as well as sufficient funding and resourcing support from organisations, said Dr Pal.
He said it was important to collect data on the volume of patients from minority groups in a particular catchment.
“Data is everything,” he said, pointing towards Cancer Australia initiatives to measure and record data accurately, something that applies directly to patients in his own clinical trials.
Self-assessment of current procedures is also a critical component of the process, to determine whether sites have appropriate protocols in place to manage each group, he said.
2. Resources – human and otherwise
Providing access to Aboriginal Liaison officers, interpreters, and oncology staff training on sexuality and gender are all valuable steps towards inclusion, said Dr Pal.
Self-assessment and analysis was important here too, he said. For instance, how many interpreters are needed, and what other resources can you provide?
“We’re further intervening by trying to create pamphlets in different languages,” he said.
Dr Pal suggested looking at the American Society of Clinical Oncology’s Equity, Diversity, and Inclusion Plan and the Peter MacCallum Cancer Centre’s diversity plan for ideas.
“These documents, these statements, and also the resources to drive them are really important,” he said.
“They have a relationship-centred care model, and you can see they have brought together these groups – culturally and linguistically diverse groups, LGBTIQA+, rural/regional, special access.”
Dr Pal emphasised the importance of clinicians identifying their own privilege and using it to have a positive impact on marginalised groups.
He urged clinicians to consider how they might use their position and influence to make real change on Monday.
“Think about yourself, how much power and privilege you might have. And then think about what you do with that power and privilege,” said Dr Pal.
“If you’re not already, maybe you could use it to advocate for one of these groups, be a change leader and inspire others to move along the action spectrum.”