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09 Feb 2023

Closing the care gap: equity in action in Victoria

  • Western Health
  • St Vincent's Hospital Melbourne
  • VCCC Alliance
  • University of Melbourne
  • Peter MacCallum Cancer Centre
  • Deakin University
  • Albury Wodonga Regional Cancer Centre

Inequities in cancer care are everyone’s problem.

Cancer remains the leading cause of disease burden in Victoria, with an average of one new cancer diagnosis every 14 minutes. Inequity in cancer care compounds this burden for certain populations, who have poorer outcomes due primarily to a lack of access and embedded systemic discrimination.

For minority groups, there is still poor-quality and missing data, invisibility within the system, and a distressing gap in cancer incidence and outcomes. The latest data from the Victorian Cancer Registry unveils these inequities, and the numbers are troubling.

Aboriginal Victorians are twice as likely to be diagnosed with cancer and three times more likely to die from cancer than other Victorians. The median age at death for an Aboriginal Victorian diagnosed with cancer is 67 years compared to 76 years, and the 5-year survival rate is 12% lower for Aboriginal Victorians.

Regional Victorians are 9% more likely to be diagnosed with cancer and nearly 10% more likely to die from cancer than those who reside in major cities. Melanoma diagnoses are also 44% higher in regional Victoria than in major cities.

Individuals from socioeconomically disadvantaged backgrounds are more likely to be diagnosed with advanced-stage cancer, and they register both higher mortality and lower 5-year survival rates.

The World Cancer Day theme – Close the care gap – has been extended this year to include a subtheme: Uniting our voices and taking action.

As part of our World Cancer Day coverage, we sat down with prominent cancer experts striving to enable more equitable care for more Victorians.

Associate Professor Craig Underhill, Director of Cancer Services at Albury Wodonga Health and VCCC Alliance Regional Oncology Lead, has seen the regional/metro divide shift remarkably in 25 years. Although there is still a disparity in incidence and outcomes for regionally based patients, Associate Professor Underhill says his patients can now access cutting-edge treatments, more treatment options, improved health services and even better access to clinical trials through innovations like the teletrials model.

Professor Justin Yeung, colorectal surgeon at Western Health, came up with the idea with a team of clinicians for a revolutionary new web-based App, Leaflet, to assist day-to-day clinical practice in one of the most culturally and linguistically diverse areas in Australia: Melbourne’s western suburbs. Complete with disease-specific QR codes, Leaflet is set to transform how patients affected by cancer at Western Health access information about their care.

Dr Claire Nightingale, a senior research fellow at the Melbourne School of Population and Global Health at the University of Melbourne, has worked in driving equitable delivery of healthcare in HIV, STIs and cervical cancer across Papua New Guinea, Myanmar and now Australia. Dr Nightingale co-leads the Supporting Choice project, which is entirely focused on eliminating cervical cancer in an equitable way by working with doctors, nurses and underserved communities to promote the option of self-collection rather than undergo an internal examination.

Cancer Council Victoria has released new research revealing the COVID-19 pandemic “exposed and deepened existing gaps in cancer care”, particularly for those already experiencing disadvantage, including regionally based Victorians, migrants and refugees. According to the report, COVID-related disruptions “intensified the [communication and language] challenges for those affected by cancer”, leading to even greater distress among migrant and refugee populations. Amanda Piper, Cancer Council Victoria’s Head of Cancer Strategy, said while inequities facing these populations continue to pose major problems for health services, we are now seeing more focus and attention given to all members of the Victorian population, particularly in the cancer sector.

Professor Jen Philip, Chair of Palliative Medicine at St Vincent’s Hospital and VCCC Alliance Academic Lead, Palliative Care is working to advocate for more equitable care for prison populations. On top of the constraints and complexities of the justice system trying to interface with the health system, people who are in prison have a life expectancy about 20 years less than the general population, due to illness, social factors, psycho-social complexity and possibly incarceration itself. Prof Philip says there’s increasing interest and movement in reform to shift the dial – albeit gradually – and have a more sophisticated and compassionate approach to healthcare for imprisoned people.

Dr Alice Bergin is a medical oncologist undertaking a PhD in the Translational Breast Cancer Genomics and Therapeutics Laboratory at the Peter MacCallum Cancer Centre, looking at patterns of disease biology for Aboriginal and Torres Strait Islander people with lung and breast cancer. Dr Bergin hopes her research will be able to determine if key differences in disease biology do exist between Aboriginal and Torres Strait Islander people and their non-Indigenous counterparts. Once identified, these differences in disease biology can address hitherto unknown causes of cancer inequity.

Dr Anita Lal, a health economist and Victorian Cancer Agency fellow, is undertaking a PhD examining the cost-effectiveness of programs to increase bowel, breast and cervical cancer screening in culturally and linguistically diverse groups. Dr Lal is working to prove tailored, in-language, culturally appropriate interventions at the prevention and screening stage have a measurable impact on downstream cancer diagnoses and outcomes.

Watch our World Cancer Day Monday Lunch Live here.

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