Introduction

From Cancer Guidelines Wiki

Access to specialist cancer care services is a significant issue faced by residents of regional, rural and remote communities in Australia and other countries with large rural populations.[1] Lack of access to specialist services is partly due to lack of visiting specialists, poor availability of specialists locally, the narrow scope of practice for rural health professionals and overall rural workforce shortages. These three factors create a cycle with the end result being a lack of specialist services close to home and the need for costly, long distance travel (Figure 1).

Figure 1.jpg

Figure 1: Limited rural access to specialist services and the need for travel[2]

Limited access to health promotion and screening services can mean that people experience the impact of poor health service access before the onset of disease. Once the disease has occurred, access issues are encountered throughout the patient journey, including access to general practitioners, specialist services, diagnostic services, treatment services, nursing and allied health services and follow-up care.[3] Poor access to health care services could be one of the contributors to the disparity in survival and disease related outcomes that exist between metropolitan and non-metropolitan patients.[4][5][6][7]

Face-to-face outreach services from metropolitan centres attempt to address some of these access issues with varying quality and intensity.[7] Most of the current models of care do not provide care on a daily basis and leave rural health clinicians to make difficult decisions without direct supervision by more experienced specialists. In addition, patients from many smaller rural towns continue to travel to larger centres for their care. Patients from larger rural centres may need to be transferred to urban centres if they become ill.[2]

Teleoncology models of care offer solutions to some of the issues faced by patients and health professionals from regional, rural and remote communities around the world. Teleoncology models of care have the potential to allow health professionals from larger centres to provide their services to patients from disadvantaged populations at many points in the patient journey from health promotion to follow-up and survivorship care.

References

  1. Hazin R, Qaddoumi I. Teleoncology: current and future applications for improving cancer care globally. Lancet Oncol 2010 Feb;11(2):204-10 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20152772.
  2. 2.0 2.1 Sabesan S, Kelly J. Are teleoncology models merely about avoiding long distance travel for patients? Eur J Cancer Care (Engl) 2014 Nov;23(6):745-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25287049.
  3. McGrath P. Post-treatment support for patients with haematological malignancies: findings from regional, rural and remote Queensland. Aust Health Rev 2000;23(4):142-50 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11256261.
  4. Jong KE, Smith DP, Yu XQ, O'Connell DL, Goldstein D, Armstrong BK. Remoteness of residence and survival from cancer in New South Wales. Med J Aust 2004 Jun 21;180(12):618-22 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15200358.
  5. Coory MD, Baade PD. Urban-rural differences in prostate cancer mortality, radical prostatectomy and prostate-specific antigen testing in Australia. Med J Aust 2005 Feb 7;182(3):112-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15698354.
  6. Sabesan S, Piliouras P. Disparity in cancer survival between urban and rural patients--how can clinicians help reduce it? Rural Remote Health 2009 Jul;9(3):1146 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19621978.
  7. 7.0 7.1 Underhill C, Bartel R, Goldstein D, Snodgrass H, Begbie S, Yates P, et al. Mapping oncology services in regional and rural Australia. Aust J Rural Health 2009 Dec;17(6):321-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19930199.