This month marks 25 years since Associate Professor Craig Underhill first moved to Albury, where he has played a leadership role in establishing the Albury Wodonga Regional Cancer Centre.
In 2023, patients affected by cancer in Albury and surrounds now have access to cutting-edge treatments – and importantly more treatment options – as well as vastly improved health services and ever-increasing access to clinical trials through innovations like the teletrials model. Teletrials refers to using telehealth for the conduct of some components of a clinical trial.
But Associate Professor Underhill says 25 years ago, the regional/metro divide was glaring.
“People used to make decisions based on access – or lack thereof – or an inability to travel. They would say ‘no’ to radiotherapy because it was too hard to relocate to the city for several weeks of treatment, and would resort to palliation with morphine instead of having radiotherapy.”
“Some women were electing to have mastectomies rather than breast conservation because they needed six weeks of radiotherapy afterwards and it was too hard with family commitments to live away from home.”
As services have improved, though, so too have the options available to patients to receive local care, and crucially, gain access to clinical trials, including through the newly unveiled teletrial model.
Data collected from Regional Trials Network Victoria sites across the state shows a huge expansion in regional clinical trial participation, with a 459% increase in the total number of patients recruited to clinical trials from regional areas from 2017-2021 (135-620).
“Access to trials is really important, because regional patients would otherwise miss out on new technologies – it would just be too hard to travel to access a clinical trial,” Associate Professor Underhill said.
“We’ve seen steps towards improving that access, and we’ve certainly seen big improvements in recruitment. But we also know that overall, there’s still about a 4% difference in outcomes for regional vs metro-based patients.
“Teletrials have a major role to play, especially in rare cancers. Hopefully we get to the point where we have a statewide or national trial, and anybody with that cancer or subtype of cancer will be able to access a trial.”
One positive effect of the pandemic has been the significant uptick in telehealth use by clinicians and patients alike, allowing more options for regional and rural patients to access health professionals and setting the foundations to deliver teletrials more broadly.
Associate Professor Underhill says the teletrials model is ripe for major investment across Victoria and Australia, not only to deliver obvious benefits to more patients, but to position Australia as a leading prospect for key international players in the clinical trial space.
“Teletrials are a win-win for everybody. If we get more people onto clinical trials, we can get the answers to scientific questions quicker – we can see whether the drugs work, and how best to use them. That can make Australia a more attractive place for industry to conduct trials.
“But this requires a national shift in thinking. The roll-out of teletrials is really in its infancy, and it’s about embedding and streamlining processes and systems to make trials accessible to more people.”
Associate Professor Underhill is bullish about the future role of teletrials in cancer care, predicting the innovative trial method will be “business as usual” within a decade.
“In 10 years’ time, I hope that we won't be having this conversation.
"I think trials will be set up so the governance, legislation and funding will take into account that you need to run trials across a network, and use telehealth to enable that.”
“We could realistically have national or global trials looking at rare cancers where centres are identified upfront as having the capability to conduct the trial. Patients could then be identified and have a rapid start-up process with a telehealth meeting before the drug is shipped and the patient can be enrolled quickly onto a trial.
“I think we'll have at least a flexible, responsive national teletrials network where we can get people access to cutting-edge treatments in a timely way.”
We’re featuring Associate Professor Underhill’s work as part of our World Cancer Day coverage, focussing on tackling inequity in cancer care across Victoria. Register for our upcoming World Cancer Day Monday Lunch Livestream here.
The Albury Wodonga Regional Cancer Centre is looking for a Regional Partnership Officer to join its Cancer Services Team. This is a newly created role providing a central point of contact between the Albury Wodonga Regional Cancer Centre (AWRCC) and the VCCC Alliance Regional Partnership Coordinator. Applications close Friday 10 February 2023. Apply now.
