We are very interested in affordable care; there is a lot going on at the moment about the costs of cancer care. So cancer is a terrible problem, we all know that; it causes great issues for patients and their care pathway is difficult and on top of that they have issues about money and governments have issues about money. So we are looking at how we can manage this issue to deliver affordable cancer care for all countries. We’re starting in high resource countries but this is definitely applicable to middle and low resource countries also. What we want to do is to think about the issue of the patient pathway because we think that if we can understand the patient pathway and develop an optimal patient pathway and reduce over-diagnosis, reduce waste, reduce over-treatment and provide high quality care we will get cost effective care. So this is the key issue, getting cost effective, value for money care. If that’s the case I believe that most countries will be able to afford it. The actual amount of money which is lost in the health system is not really known but we do know there’s a lot of evidence of waste, of over-treatment and over-diagnosis.
And how are you going about doing that? You’re doing it here in Victoria, a pilot scheme?
Yes, we’re doing this. We have two main thrusts to this, firstly we have a large forum, which is the wish forum, going ahead which will be discussed in February and a document produced at that time, which will put forward the views which can be picked up by the policy makers and the health administrators. Because this is a high level issue, it’s not going to be done at the lower level unless there’s a very compelling argument put to the professionals. I’m a great believer in professionalism; I think we have to return to putting the pressure on our professional colleagues to make sure that they do treat their patients according to this sort of pathway. So we know in a lot of our guidelines, we’ve had guidelines for many, many decades really, and we know the problem is about adherence to guidelines. I actually think that professionals will understand what the right treatment is but what they don’t understand is providing efficient treatment. They need help in making treatment decisions about end of life care, when you introduce palliation, how many scans should an early breast cancer patient have, they don’t need any actually because there’s 98% survival from breast cancer in that early stage. So these are the sort of things we’re working on.
To implement this sort of programme is quite complex because it introduces a regular problem we’ve known about for a long time, that is how do we get data, how do we infuse the pathway with data and how do we infuse the pathway with costs. So we think that having this in a transparent way will also be helpful. We think the decision should be a discussion occurring between patient and the doctor and the health system about their pathway and how they want to go. Now I actually believe that doctors will conform to the pathway if they understand the issue and mostly they don’t. They look at an isolated issue, an isolated item of care, an isolated problem they have to deal with and they don’t realise that there’s another step. So these are the sorts of things we want to work on.
And the issue of survivorship is now becoming real.
Absolutely. Survivorship is a big area of action and I think survivorship, which essentially means lets work out how we can manage patients after they’ve finished their treatment, there is a lot of talk about whether survivorship issues start earlier but I think they basically occur after the treatment is over. The real point is to both improve patient experience and also keep the patients out of the medical system. I personally think if I get cancer and I get treated for it I’d be very happy never to see a doctor again and I’m happy to see someone who can help me with my thoughts and my concerns. I had a patient once who was treated and she had a nasty cancer, she had an anal cancer, and they treat anal cancer with chemoradiation. She was treated and she was cured of her cancer. She came to see me for follow-up and she said, “I’m not very happy.” I said, “What’s your trouble? You’ve been cured of your cancer.” She said, “That is the issue. I’ve had cancer, nobody tells me how to manage that issue. When I go to the golf club all they want to know about is cancer and it’s driving me mad. And I have problems following the chemoradiation in that neck of the woods, down in my pelvic region, and no-one is interested.” So this is survivorship and there’s a case for de-medicalising survivorship, taking it out of that medical arena and having patients managed in a way which helps their experience and also reduces cost and reduces burden on the medical system.
