Doing our Best to Reduce Inequality in Cancer Care

A uro-oncology medical placement at Peter MacCallum Cancer Centre in Melbourne brings up questions of geographical discrimination in cancer care across Australia and the future of healthcare globally for Liang Qu FRSA.

The beautiful and elegant facilities I saw at Peter MacCallum Cancer Centre (PMCC) brought me feelings of awe and excitement. However, in addition to the buzz, a recurring thought played over in my mind as I went about my placement: these wonderful facilities may only be utilised by those living in the nearby area – so what about the others? What level of cancer care is provided elsewhere? There are endless reasons why living in a metropolitan city like Melbourne can be preferable to a rural residential location; one possible reason, which may not surface until a family is faced with the devastating implications of a cancer diagnosis, is the accessibility of high quality healthcare.

At PMCC, cancer care is streamlined, efficient and comprehensive. Instead of offering segregated surgical, medical, and radiation services that do not communicate effectively with one another, PMCC runs clinics in tumour streams rather than by medical specialty. For example, the ‘Genitourinary Oncology Clinic’ runs with representation from urological surgeons, medical oncologists, radiation oncologists, nurse cystoscopists, and sexual medicine counsellors, as well as administrative and booking staff. Coordinating cancer care for a patient with advanced prostate cancer would be done simply by walking down the clinic corridor and introducing a patient and their loved ones to a fellow healthcare practitioner. Obstructive urinary symptoms would be immediately investigated with nursing staff organising urinary flow investigations; patients concerned about erectile function post radical prostatectomy are seen soon after by the sexual health nurse practitioner; patients who are to undergo surgery are consented efficiently, and seen thereafter by the booking staff who coordinate the theatre operating waiting lists. Simple face-to-face liaison between healthcare professionals ensures patients have their issues comprehensively addressed, with minimal loss to follow up.

Prostate cancer is treated at PMCC with technology that is available only at a limited number of advanced healthcare facilities. The use of the dual console Da Vinci Xi Robotic Surgical system is a setup that PMCC boasts in being the only centre in Australia that has one, enabling not only operations that are performed efficiently and with precision, but also allowing for a coveted opportunity for robotic surgical training for fellows and registrars. The robotic surgical system enables radical prostatectomies to be performed instead of the traditional open procedure. Although oncological outcomes such as overall survival and cancer recurrence are similar to open procedures, robotic procedures allow for fewer surgical complications like bleeding, are cosmetically nicer (small port-site scars versus large midline scars), and also allow for shorter post-operative hospital stays (one versus three or four days). From a patient’s point of view, this option would be preferable, but is it not obvious that such a procedure has an extremely limited accessibility? It is saddening to see that patients would be geographically discriminated against advanced treatments like robotic prostatectomies, resulting in an imbalance in the quality of healthcare provision across Australia.

Despite the limited access to robotic procedures, I was glad to hear that PMCC does its best to enable patients across Australia to benefit from their care. Not only has PMCC committed to delivering healthcare primarily for the public healthcare system (essentially allowing for robotic procedures without expenses for patients), but it has also been known to fly patients over to the centre for treatment from areas across Australia, including regional Victoria and Queensland. In addition, the workup for prostate cancer requires staging scans pre-operatively to any treatment planned. The PSMA PET/CT scan would normally cost a patient out of pocket $AUD5-600 as a minimum. At PMCC, I was pleasantly surprised to hear that patients being treated at this centre received these scans free of charge, with PMCC absorbing the costs altogether. Seeing the magnanimous gestures offered by PMCC truly humbled me to see what healthcare should ideally be like, and that in essence, this centre acts as a ‘haven’ of healthcare for patients who need it the most desperately.

My only hope for the future, not only for cancer care but for all healthcare, is for more of these ‘havens’ to appear throughout Australia and worldwide. I hope for healthcare facilities to do what they can in their own powers to minimise inequality in accessibility and availability of quality healthcare. Medicine is a noble profession, where we naturally assume the role of putting the patient’s best interests at heart. It is our job as current and future healthcare professionals to uphold this value, and to remind ourselves that there is always more to be done. I would like to end by sharing a quote widely displayed around the PMCC building for patients and staff to reflect on, as I have done so in this report:

“Nothing but the best is good enough in the treatment of cancer” Sir Peter MacCallum, 1949

Liang Qu FRSA is a medical student and researcher, with special interests in cancer care and global health.