The debate continues...
One of the highlights of the VCCC Research Conference in September was the Great Debate.
Amid the wit (and occasional slander!) of the debate, the arguments revealed the complexity of the topic – further demonstrated by the difficulty both teams had staying on their side of the debate!
On the Good Luck side was Professor Mark Jenkins, Director of the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health and Centre for Cancer Research at the University of Melbourne, and on Good Management was Professor Kate Drummond AM, Director of Neurosurgery at The Royal Melbourne Hospital and Head of Central Nervous System Tumours for Parkville precinct cancer services. Reflecting on the debate, the two agree that while Victoria has some of the best survival rates in the world, outcomes are not the same for all Victorians and there is more to be done.
“There is no doubt good luck plays a role,” says Mark. “Victoria is a small, wealthy state with relatively high education levels and comparatively low barriers in terms of distance and access for rural and regional patients. This is a distinct advantage compared to other larger and more sparsely populated states, and even international comparisons.”
Mark also observes that good luck is a key determinant for individual outcomes. He points out that it matters a great deal where you live, and it matters what your cultural background is, as well as your socio-economic status.
“Better outcomes correlate with higher screening participation rates and earlier detection,” he said. “There is a clear alignment with areas with higher education levels, higher socio-economic position, areas with lower proportions of culturally and linguistically diverse communities, and more specialised and dedicated cancer resources.
“For individuals this means your cancer experience is, at least in part, a matter of good luck. Disparities like these are not unique to Victoria, but in a state with such outstanding overall cancer care, it presents a major challenge to improve access and equity for all Victorians. This is a clear opportunity for the VCCC to work collaboratively with the government and health care networks to apply creativity, technology and innovation to overcome this entrenched problem.”
On this point Kate Drummond agrees. “Victoria, especially Melbourne, and more specifically Parkville, has an extraordinary concentration and culture of innovative bio-medical research, ongoing investment, world-class education and talent retention. This is a result of long-term investments by government, philanthropy and institutions dedicated to excellent health care outcomes,” she said.
“This is a clear demonstration of good management. The survival rates where there is this concentration of resources is no accident – we know how to do this. The issue is how we get this standard to more people, more of the time. Resources are an obvious limitation so efficiencies and collaborations are critical.”
Kate says Victoria’s excellent screening and early detection initiatives are also key to the state’s good results, with early detection a particularly important factor in high survival rates.
“The Quit campaign; Slip Slop, Slap and the screening programs for breast, bowel, cervical and prostate cancers are demonstrations of Victoria’s track record of good management. We are on track to eliminate cervical cancer by 2040. That will be a world first – only possible when the system is working.”
Kate also cites the development of Optimal Care Pathways – evidence based, system-wide approaches that guide best practice approaches to treatment - as another achievement of good management in the state.
“We have a Victorian Cancer Plan and innovations like the VCCC and MPCCC that are building new silo-busting collaborations. That’s good management. But we can do much more.
“Screening participation varies across the state and could be much higher still, especially in bowel cancer. From there we need to ensure the system can cope with follow-ups for positive screening tests. We have banned sun beds as they were proven to cause cancer and yet we still sell cigarettes.”
Kate also believes we should take a bigger picture view.
“There is too much tumour stream focus,” she says. “We need to look at the whole system which would allow for more pragmatic decisions to benefit more people. That might mean making tough decisions for the greater good,” she said.
Holding the cards
Victoria’s achievements as a world leader in cancer survival can be attributed to a multiplicity of factors – some luck and much good management.
As the Victorian Government develops its next Cancer Plan, we have even more cards in our hands. We have only just scratched the surface of the potential for telehealth and digital care to help equalise access for rural and regional areas. VCCC collaborations have driven new access to health services data that will help measure and locate inequities and opportunities. We have rapid access to genomics assessments to sharpen treatment targets as well as novel approaches to boost clinical trials participation. And immunotherapy research is bringing a revolution in therapeutic options.
As cancer survival continues to improve and we increasingly treat it as a chronic disease, perhaps the next debate will be whether we should look beyond measures such as five-year survival to gauge success. Could return to work rates be more useful as the health system adapts to deal with new scenarios for patients with cancer around survivorship, quality of life and wellbeing?
The ultimate goal is to take good luck out of the equation and work towards equity and better outcomes for all.
VCCC Research Conference Great Debate teams
Facilitated by Associate Professor Roger Milne, Cancer Council Victoria
Professor Eva Segelov, Monash University
Professor Robert Thomas OAM, VCCC Deputy Chair, Chief Advisor on Cancer to the Victorian Government
Professor Kate Drummond AM, The Royal Melbourne Hospital
Helen Farrugia, Victorian Cancer Registry
Professor Mark Jenkins, The University of Melbourne
Professor Mark Rosenthal, Peter MacCallum Cancer Centre