Rural Oncology Update

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Rural Oncology Update

• Dorothy Keefe
• TCCSA Professor of Cancer Medicine, University of
  Adelaide
• Clinical Director RAH Cancer Centre
• Deputy Chair SA Cancer Network
• Chair MBBS Curriculum Committee (Operations)

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What am I going to talk about?

• The Statewide Cancer Network
• Education
• Clinical Challenges in Rural Oncology

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Ideal Cancer Care

• We all know that the aim is to provide
• Worlds best evidence-based, patient-centred
  cancer care for all
• Whatever the location
• Rural or Metropolitan
• Whatever the financial status
• Public/Private
• Whatever the cultural or linguistic background
• Aboriginal, CALD

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South Australian Issues

• City State
• Small and distant rural population
• No Oncologists outside Metropolitan Adelaide
• Vast distances
• Tiny rural towns and Cities
• Small Population
• Just over 1.5 million people
• 75 live in metropolitan area
• Ageing (highest median age in Aus)

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Workforce

• Problems with attraction and retention
• Lower remuneration
• Limited career options
• Low morale
• Competition from other states for staff
• Staff also Ageing
• Succession planning inadequate

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State Health

• State too small to have duplicate services
• Inter-hospital rivalries
• State-wide cancer control plan launched but not
  implemented
• Funding required
• Cancer Registry run-down
• IT infrastructure inadequate

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What do we have already?

• Statewide Cancer Control Plan 2006-2009
• Launched but not implemented
• Statewide Cancer Network
• Just getting going
• South Australias Health Care Plan
• The new hospital
• ABHI
• Cancer Australia CanNet project
• Rural Chemotherapy Mentoring Program

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ABHI

• Australian Better Health Initiative
• Funding for several cancer care coordinators
• 1 in Southern
• 2 in CNAHS
• 1 in CYWHS
• Activities aligned with Cancer Network and CanNet

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CanNet

• Cancer Service Networks National Demonstration
  Program
• DoH has been awarded 1m as a CanNet grant which
  is being used to fund the development of a South
  Australian Cancer Network

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Rural Chemotherapy Mentoring Program

• Run out of Country Health
• Organises placements for rural/remote doctors and
  nurses in the City
• Provides education and establishes links
• Aims to
• Increase/improve chemotherapy delivery in country
• Improve understanding of toxicity management

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SA Health Cancer Network

• Charged with guiding the implementation of the
  State-wide Cancer Control Plan, in line with the
  new State Health Plan

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Subcommittees

• Cancer prevention and early detection
• Optimising cancer care
• Infrastructure planning
• Workforce planning
• Cancer Control Research
• Cancer Information

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Optimising Cancer Care subcommittee ..

• Patient journey

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Plans

• Appointed a Project Manager
• 3 tumours as test cases
• Upper GI
• Adolescent/Young Adult
• Lymphoma
• Working party for each charged with developing a
  patient pathway
• Proof-of-concept for other tumours
• Resource development

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MBBS Curriculum, University of AdelaideThe
triple spiral

• Concept maps for content
• PBL for 1st three years
• Cases
• Resource sessions
• Supporting Lectures
• Clinical skills and MPPD
• Exposure to patients in 1st year
• Horizontal and vertical integration
• Reinforcing and increasing sophistication as
  progress
• Mapping and tracking
• To ensure optimum coverage of content
• Years 4-6 are hospital based
• Mainly clinical but with SBM and MPPD embedded

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Graduate Outcomes

• Undifferentiated doctor with abilities and skills
  for
• Seamless transition to post-graduate training
• Continuing into advanced training in any area
• Distinguishing features
• Adult learners who enjoy pursuit of life-long
  learning
• Superior integration of knowledge across
  disciplines
• Application of basic science into clinical
  management
• High sense of duty of care

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Outcomes of Special Interest

• Prepared for Internship in 2006
• Excellent communicators self-directed learners
• Experience of
• Rural medicine
• Preventative medicine/Public health
• Cost pressures
• Critical reasoning and research methodology
• Ethically aware trained in social justice and
  equity issues
• IT-literate
• Special attention has been paid to
• Indigenous culture and health issues,
• Gay and lesbian issues,
• Health relating to Persons with disability

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Factors affecting teaching within the Health
System

• Hospital medical staff are extremely busy
• Increasing pressure on service delivery
• Teaching time is vulnerable
• Staff who teach are not valued and rewarded for
  teaching
• GPs are likewise extremely busy and not funded
  well for teaching
• There is a risk that we will not be able to
  adequately train the doctors of the future

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The Future

• We need to look at the requirements for doctors
  in 2015
• Increases in Medical knowledge make it impossible
  to know everything
• Consideration needs to be given to
• Core competencies
• Shorter undergraduate courses
• Changes to intern and early post-graduate
  training
• The idea of returning to education at different
  stages of career
• What impact will the State Health Plan have?
• Curriculum review is necessarily ongoing and
  permanent!

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Regional Survey

• A survey of nursing and medical staff was
• conducted throughout country S.A.
• This survey was developed to
• - Identify gaps in oncology knowledge and skills
• - Identify what education strategies are
  preferred by regional clinicians and
• Identify the problems clinicians encounter in
  caring for chemo patients

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Survey Results

• 60 of people surveyed returned the questionnaire
• 9 rated themselves a 4/4 for their knowledge of
  chemotherapy
• 15 rated themselves a 4/4 for their confidence
  in administering chemotherapy
• 57 have had education sessions on cancer or
  chemo
• 19 rated themselves a 4/4 to safely access and
  de-access an infusaport
• 20 rated themselves a 4/4 to take bloods from
  and administer IVABs to a central venous line

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Top 20 diagnoses on separation from Adelaide
hospitals (excluding private) by country
residents (2005 -2006)
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Clinical Issues for Rural Doctors

• Access to specialist advice
• Better ability to give cancer treatment locally
• LMHS Linear Accelerator
• ?Whyalla next
• Chemotherapy training
• Better knowledge of supportive care and help in
  emergencies
• ?Single telephone number for cancer help

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Management of Toxicities

• In-house mostly done by protocol
• These need to be readily available from treatment
  centres
• Web access would be preferable
• Cancer Australia could act as a repository
• Ci-Scat has quite a few

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The Way Forward

• The Cancer Network needs to ensure the needs of
  rural/remote patients and practitioners are
  included in everything it does
• The Optimising Cancer Care Committee needs to
  produce resources that are readily available
  address the issues
• The RCMP and ABHI initiatives will improve
  communication
• We will look at a single number system

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Conclusion

• Every level of service is affected by the State
  Health Care Plan
• Constructive engagement will produce the best
  outcomes
• All roads seem to be leading to Rome in terms of
  Network, CanNet, ABHI, RCMP
• Ongoing communication is the key