Tailored models of care
The cancer care service models for regional and rural Australia should be tailored to suit the needs of local communities. The cultural and geographical variations in regional Australia must be accounted for when modelling healthcare provision. The importance of planning in the radiation oncology sector is enunciated in the section entitled A Forward‐Looking Strategy to Deliver Improved Radiation Oncology Services: Importance of Planning, on providing a quality radiation oncology service.
To further strengthen the effectiveness of planning in rural and regional areas, cooperative involvement of key stakeholders is required. Such stakeholders include providers of radiation oncology services, regional health authorities, other service providers, patients and communities. A specific example for radiation oncology is the need for transparent infrastructure planning and the taking into account of existing private sector radiation oncology infrastructure. Consideration of costs of developing regional public facilities as opposed to providing publicly-funded access to an existing private facility is an important financial variable in this question. In this context, the advantages of public-private partnerships should be explored.
Links to a comprehensive cancers service
The lessons learned from the previous Radiation Oncology Capital Works Programs (RORIC Symposium)13 highlight the need for planning a comprehensive service when establishing regional cancer centres. This planning ought to focus on the health outcomes and patient experiences including the provision for integrated multidisciplinary care.
The importance of MDT care for cancer patients is explored in detail in A Patient-Centred, Evidence-Based and Multidisciplinary Approach to Care: Evidence based multi-disciplinary oncology practice, on providing a quality radiation oncology service. Currently, some of the barriers to referral for radiotherapy treatment include: experience and training of the individual referring practitioner, training and their level of understanding of radiotherapy28. Participation in MDTs improves referring physician’s knowledge of radiation oncology and increases referrals for clinically appropriate radiotherapy treatments. Enabling MDT care in the specific circumstances of each regional and rural facility is a priority for quality patient care.
Networking and cooperation are critical in health care broadly, but more so in rural and regional centres. One radiation oncology expert from a regional cancer centre responded to a question ‘how can rural and regional access to radiation oncology be improved?’ as follows: better networks for transferring patients, better linkages to health services, better linkages to allied health, better ancillary supports, and better information technology systems to support care.
Access to allied health services
Allied health services are part of holistic cancer care and must be included in planning of any comprehensive cancer care system. Historically, the role of allied health staff, including but not limited to psychologists, social workers, physiotherapists, occupational therapists, speech pathologists, exercise physiologists and dietitians, and of nurses in radiation oncology has not been emphasised. In the absence of allied health services, cancer patients’ management can be fragmented, and they can experience treatment-related problems such as social and emotional consequences29. To illustrate this point, an individual diagnosed with head and neck cancer will fail to achieve excellent outcomes if their nutritional status is so compromised after treatment that they are not able to regain adequate functional capacity to return to work.
Current funding models for radiation oncology, which support patient access to radiotherapy treatments, are insufficient to fund allied health support. As a result, in rural and regional areas allied health support is often only available privately and at a financial cost to the patient and their carers and family. Stakeholder submissions to the Plan noted that access to allied health services is improving in the cities, particularly in the larger cancer centres, but is difficult for rural and regional patients.