Radiation Oncology Services in Australia – Key Issues

Issues impacting on the quality of service provision

• Fragmented planning of specialist oncological services, radiation oncology infrastructure and workforce;
• Variability in access to timely radiotherapy treatments across both geographic locations and cancer types;
• Lack of implemented and permanent national initiatives focused on quality and safety, including:
  • Radiation Oncology Practice Standards for facilities are not mandatory;
  • There is no nationally implemented minimum radiation oncology dataset to guide planning;
  • There is no incident monitoring system across Australia that is appropriate for radiotherapy;
  • Australian Clinical Dosimetry Service is funded only as a pilot.
• Problems persisting with the timely and safe introduction, evaluation, uptake and patient reimbursement for modern techniques and technologies in radiation oncology.

Resources to support the delivery of services

• The current numbers and trends in the availability of workforce and linear accelerators (linacs) are not sufficient to meet the target optimal utilisation rate of 52.3% of new cancer patients either in 2012 or in 2022;
• There is a lack of effective coordination between bodies responsible for workforce, resources and infrastructure planning;
• A critical barrier for patients to access radiotherapy is their proximity to radiation oncology facilities;
• Appropriate imaging and specialised radiotherapy techniques (such as IMRT) are not cohesively incorporated into service plans and infrastructure planning;
• Ongoing resourcing for the national program of equipment replacement within agreed lifespans is essential to ensure that radiotherapy equipment is kept current.

Access to services for rural and regional patients

There are multiple barriers for rural and regional cancer patients to access services:

• The availability of quality and timely cancer care;
  • Financial burden of cancer and its treatment has a disproportionate impact on patients based on their geographical location;
  • Travel to receive treatments and the associated social burden;
  • Opportunities in communications technology still waiting to be harnessed to improve care and patient convenience;
• Rural and regional radiotherapy centres face challenges with recruitment and retention of workforce;
• Lack of effective coordination in service planning and workforce development for rural service provision.

Access to services for Aboriginal and Torres Strait Islander patients

Indigenous Australians have unique needs with respect to radiation oncology for the following reasons:

• Different patterns of cancer incidence compared to non-Indigenous Australians;
• Later diagnosis and lower survival;
• Continued disadvantage in accessing treatments;
• Cultural considerations;
• Limited data and research on Indigenous cancer care, particularly in metropolitan settings.

Research and academia as foundations of future practice

Research in radiation oncology provides direct clinical benefit to patients (measurable outcomes, used in diagnosis and treatment).

• Radiation oncology research in Australia lacks capacity and resources,
  • This limits capability for developing and implementing advances in patient care, and for workforce training and development;
  • There is disparity of research funding for radiation oncology compared to its clinical benefit to patients;
  • The impact of this may be greater in regional and rural facilities
• Research in radiation oncology is different to pharmacological based research in that:
  • Randomised clinical trials are more difficult;
  • Lack of clinical data collection to evaluate technologies;
  • Novel methodologies are required to evaluate new technologies;
• There is further potential for collaboration between the various research groups, institutions, professions and individuals involved in cancer research.