Survivorship Care, the Poor Cousin of Australian Cancer Services: Findings From a National Cross-Sectional Survey

Abstract

Background: The significant role of survivorship care in improving the outcomes and experiences of cancer survivors is increasingly being recognised. In response to the changing health service landscape in Australia, this study aimed to map cancer services and identify important service gaps and factors associated with service provision. Methods: A mixed-method, prospective, cross-sectional survey was conducted throughout 2016. Government or privately-owned, hospital or community-based healthcare organisations with dedicated cancer services were identified. Each organisation was invited to nominate a staff member to answer a purpose specific online/paper questionnaire. Included was an open-ended question that asked about the most important unmet service needs and gaps in their region. Descriptive statistics, standardised rates, and single level and multilevel multinomial logistic regression were used to analyse the data that was augmented with a qualitative descriptive analysis. Findings: Of the 295 eligible organisations that were identified, 93·2% responded. After adjusting for remoteness, compared to government operated services, for-profit companies were significantly more likely to provide only one or two types of cancer services (e.g. radiotherapy) in a limited range of settings (e.g. day hospital with no in-patient or home care) (p<0·001) and less likely to provide comprehensive survivorship services (p<0·001). Survivorship services, either during or after treatment (e.g. allied health, psychosocial support) were most commonly identified by providers as the most pressing service gaps in major cities, rural and remote regions alike. This included the need for improved integration, outreach and affordability of these services. After adjusting for ownership and the respondent's role in the organisation, compared to major cities, remote regions of Australia were more likely to have service gaps that are dependent upon specialist oncology services (p=0.003). Interpretation: The findings from this survey provide intelligence for health service planning and policy in Australia along with insights for other countries with mixed public-private healthcare. Despite being a high-income country with well-established prevention, primary and secondary care, the challenge of providing equitable care across the continuum of cancer care persists. The low rate of service survivorship services in the for-profit sector suggests that current policies are failing to incentivise their provision. The results support calls for innovative service models and funding mechanisms that shift the focus from cancer to the survivor and deliver integrated and equitable cancer care across both the public and private health sectors. Funding: Western Sydney University in partnership with South West Sydney Local Health District and Oncology Massage Ltd. Declaration of Interests: Authors CS, JH, KT and SG are academic researchers at NICM Health Research Institute. The institute receives research grants and donations from foundations, universities, government agencies, individuals and industry. Sponsors and donors provide untied funding for work to advance the vision and mission of the institute. The project that is the subject of this article was not undertaken as part of a contractual relationship with any donor or sponsor. Author GD is Director of Cancer Services for the South Western Sydney Local Health District and Director of Liverpool Cancer Centre in Australia. Author JH is a general practitioner with a clinical interest in evidence-based integrative medicine. Author SG works as an acupuncturist at the Chris O’Brien Lifehouse cancer treatment center in Camperdown, Australia. Author JU is an academic researcher at the Translational Research Institute that receives research grants from foundations, universities, government agencies, and industry. The institute and JU have no competing interests to declare. Ethics: Approval was obtained from Western Sydney University Human Research Ethic Committee (HREC) (H11389) and the Joint University of Wollongong and Illawarra Shoalhaven Local Health District Health and Medical HREC (HREC/16/WGONG/178).