Sabe Sabesan

6539 Background: Rate of survival from head and neck (H and N) cancer is lower among rural patients compared with their urban counterparts. This study’s aim was to examine whether there was any difference between Urban (U) and rural (R) areas in the time taken to receive various aspects of H and N cancer management. Methods: H and N cancer patients presenting to Townsville, Cairns and Mackay hospitals were prospectively recruited from January 2009 to January 2011. The demographic factors as well as median times between 1) symptoms and first consultation, 2) symptoms and referral to specialist, 3) symptoms and visit to specialist, 4 ) symptoms and first treatment, 5) diagnosis and first treatment, 6) consultation and referral to specialist, and 7) visit to specialist and treatment, were collected. Fisher’s, Kruskal-Wallis and Mann-Whitney tests were used to compare the two groups. Results: Out of the total of 158 patients , 62 % were living in urban and 37.3 % were living in rural areas. According to univariate analysis, there was significant difference in median time between diagnosis and first treatment between U and R areas (p=0.015). Indigenous patients had significant delays from diagnosis to first treatment (p=0.013), and visit to a specialist and treatment (p=0.031), compared to non-indigenous patients. According to multivariate analysis, there was significant delay in time between symptoms and first treatment in low-income compared to high-income population (P =0.03) and in patients with lower level of education compared to those with higher level of education ( P=0.04). There was significant delay in time between diagnosis and treatment for patients living in R area compared to those living in U area (P=0.028). The time between first consultation and referral to a specialist and time between visit to specialist and treatment was significantly longer in patients living in R areas compared to U area ( P=0.025 and P=0.003). Conclusions: There are delays in various aspects of head and neck cancer management depending on remoteness of residence and socio-economic factors. Improvement in management pathways for rural patients may improve their survival rates from H and N cancer.

Objective: To conduct a cost analysis of a telemedicine model for cancer care (teleoncology) in northern Queensland, Australia, compared with the usual model of care from the perspective of the Townsville and other participating hospital and health services.Design: Retrospective cost–savings analysis; and a one-way sensitivity analysis performed to test the robustness of findings in net savings.Participants and setting: Records of ...

Background To provide equality of cancer care to rural patients, Townsville Cancer Centre administers intensive chemotherapy regimens to rural patients with node‐positive breast and metastatic colorectal cancers at the same doses as urban patients. Side‐effects were usually managed by rural general practitioners locally. Aim The aim is to determine the safety of this practice by comparing the profile of serious adverse events and dose intensities between urban and rural patients at the Townsville Cancer Centre. Method A retrospective audit was conducted in patients with metastatic colorectal and node‐positive breast cancers during a 24‐month period. Fisher's exact test was used for analysis. Rurality was determined as per rural, remote and metropolitan classification. Results Of the 121 patients included, 70 and 51 patients had breast and colon cancers respectively. The urban versus rural patient split among all patients, breast and colorectal cancer subgroups was 68 versus 53, 43 versus 27 and 25 versus 26 respectively. A total of 421 cycles was given with dose intensity of >95% for breast cancer in both groups (P > 0.05). Rate of febrile neutropenia was 9.3% versus 7.4% (P = 0.56). For XELOX, rate of diarrhoea was 20% versus 19% (P = 0.66) and rate of vomiting was 20% versus 11% (P = 0.11). Only two patients were transferred to Townsville for admission. No toxic death occurred in either group. Conclusion It appears safe to administer intensive chemotherapy regimens at standard doses to rural patients without increased morbidity or mortality. Support for general practitioners through phone or videoconferencing may reduce the safety concerns.

Problem:  Townsville Cancer Centre provides video‐consultation (VC) services to patients in rural/remote regions of North Queensland in order to improve access to specialist cancer care. The experience and responses of indigenous patients using this service have not been studied. Our objective is to assess the level of satisfaction and the responses of Indigenous patients, their families and health workers (HWs) to VC and such teleoncology service.Design:  Descriptive study, using semistructured interviews.Setting:  Tertiary referral centre (Townsville Cancer Centre) and various rural and remote towns in Queensland.Key measures for improvement:  Satisfaction levels of Indigenous patients, their family members and Indigenous HWs with various aspects of the teleoncology service.Lessons learnt:  Our evaluation suggests that teleoncology is an acceptable model of care for Indigenous patients, with high levels of satisfaction expressed from patients, families and HWs. Health professionals involved with providing this service need to be adaptive to the needs of individual patients and local communities in order to provide culturally appropriate care. Formal skills training for staff, effective communication between specialist and local HWs, and informed consent procedures are essential to maintain safety of practices. Strategies for change are: Mandatory informed consent procedure for all patients offered with VC. Formalised competency training for staff in skills essential to maintain safe practices in teleoncology. Clear clinical documentation to facilitate improved communication in patient management between medical staff at main centre and distant sites. Further efforts in promotion, education and support for staff to participate in telemedicine.

Objective:  To describe the use of telemedicine in cancer care (teleoncology model of care) for rural patients in North Queensland.Design:  This is a descriptive study. Data on demographical and clinical factors were retrieved from the teleoncology database of Townsville Hospital and review of medical records for the period between May 2007 and May 2011.Setting and Participants:  The medical oncologists at the Townsville Cancer Centre, a regional cancer centre in North Queensland, have been providing their services to rural hospitals in Townsville and Mt Isa districts via videoconferencing since 2007.Intervention:  Cancer care delivery to rural sites via Townsville teleoncology model.Main Outcome Measures:  The ability of the teleoncology model to provide the following services to rural towns: (i) specialist consultations; (ii) urgent specialist medical care; (iii) care for Indigenous patients; and (iv) remote supervision of chemotherapy administration.Results:  Between May 2007 and May 2011, 158 patients from 18 rural towns received a total of 745 consultations. Ten of these patients were consulted urgently and treatment plans initiated locally, avoiding interhospital transfers. Eighteen Indigenous patients received consultative services, being accompanied by more than four to six family members. Eighty‐three patients received a range of intravenous and oral chemotherapy regimens in Mt Isa and oral agents in other towns through remote supervision by medical oncologists from Townsville.Conclusion:  Teleoncology model of care allows rural and Indigenous cancer patients to receive specialist consultations and chemotherapy treatments closer to home, thus minimising the access difficulties faced by the rural sector.

Aims:  In this retrospective analysis, we describe the efficacy and tolerability of weekly cisplatin 40 mg/m² used in concurrent chemoradiation of head and neck cancer at the Townsville Cancer Centre.Methods:  Review of medical records of patients who received radical chemoradiotherapy for head and neck cancer at Townsville Cancer Centre from 2003 to 2009.Results:  In all 102 patients were analysed, 62 of whom had definitive chemoradiation and the remainder adjuvant chemoradiotherapy. Median follow up was 20.1 months (range 5–86 months). Overall 68.6% of patients received 5 weeks or more of planned chemotherapy. Radiotherapy interruptions occurred in four (6.4%) patients. The rate of grade 3–4 adverse events was 51% including neutropenia (18.6%), mucositis (21.8%) and dysphagia (12.9%) and 30.7% of patients needed hospital admission to manage toxicities. For definitive and adjuvant groups, estimated 3‐year survival was 64.5 and 71.5%, respectively, and estimated 3‐year disease‐specific survival rates were 70.3 and 81.6%, respectively. The 3‐year overall survival for patients who received five or more cycles of chemotherapy was 75.2%, compared to 52.6% for those receiving fewer than five cycles (P = 0.018).Conclusion:  Despite this is being a small retrospective study, survival figures and toxicity profiles of low dose weekly cisplatin are comparable to historical controls using high‐dose regimens, hence justifying our approach. In addition, radiotherapy interruptions are minimized and cisplatin is easy to administer in outpatient settings. Future three‐arm studies could include this regimen as the basis of treatment combined with targeted therapies.

Background: Since 2007, Townsville Cancer Centre (Queensland, Australia) has provided routine and urgent medical oncology services to rural and remote communities through videoconferencing. At remote sites, patients were accompanied by doctors and other health workers. The aim of this study was to describe satisfaction of patients and rural health workers with this model of teleoncology. Methods: Between May 2007 and June 2010, 55 videoconferencing patients were invited to participate in a questionnaire-based telephone survey after informed consent. The survey included responses to 16 satisfaction statements using a 5-point Likert scale. Perspectives of health workers involved were recorded using open-ended questions on six themes related to telehealth. Results: Among the 50 participating cancer patients, median age was 56 years (range 28–83). Seventy-six per cent of patients thought specialist physical examination was important despite local doctors performing it. Seventy-six per cent of patients felt the presence of accompanying local health workers was not important. Seventy-eight per cent of patients preferred to be seen in Mt Isa for the first consultation through videoconferencing than travelling to Townsville. More than 80% of patients were in agreement with the rest of the satisfaction statements. Ninety-six per cent of patients were in agreement with the question relating to overall satisfaction. Eighteen health workers participated and their responses and attitudes were favourable towards telehealth. Conclusion: Satisfaction with this model of care was proven to be high among both patients and health workers. Benefits perceived included effective communication between patients and specialists, reduced travel time and money expenditure, and superior specialist support for rural health workers.

RRH: Rural and Remote Health. Published article number: 1146 - Disparity in cancer survival between urban and rural patients - how can clinicians help reduce it?