Townsville Cancer Centre Research Articles

Administration of immune checkpoint inhibitors at rural towns using the Teleoncology model of care-A North Queensland perspective.

This study aimed at evaluating the safety of administering immune checkpoint inhibitors (ICIs) and monitoring for immune-related adverse events (irAEs) using the Teleoncology model of care. A retrospective cohort study comparing two patient groups. The North Queensland Teleoncology Network (NQTN) operated by the Townsville (THHS) and Cairns Hospital Health Services (CHHS) with the Townsville Cancer Centre (TCC) acting as the control group setting. Patients who received ICI treatment via the NQTN between January 2015 and April 2019. Patients who received ICI at the TCC over the same time period were used for comparison. Rates of high-grade irAEs and irAE-related deaths. Fifty-two patients received a total of 822 cycles of ICIs via the Teleoncology model through NQTN. Over the same time period, 142 patients received a total of 1521 cycles at the TCC. There were no significant differences in all demographic characteristics between either group, including tumour profile and Indigenous status. There were no statistically significant differences between the rates of high-grade irAE across multiple body organ systems (p = 0.151) and rate of hospital admissions (13.5% (NQTN) vs 5.6% (TCC), p = 0.702). There were no irAE-related deaths in either group. The results suggest that with adequate governance and clinical resources, ICIs can be administered safely using Teleoncology models to rural and remote towns.

Medical Oncology Care Plan: a tool for improving the provision of clinical information to patients.

Improving clinical communication between patient and clinician through the provision of written information empowers patients to make informed decisions, underpinning patient-centred care and leading to greater health outcomes. The Townsville Cancer Centre has formulated a holistic care plan template for each patient as a tool to enhance this communication. Using questionnaire-based and qualitative surveys, understanding of the patient's cancer and perspectives of clinicians were examined. The results demonstrate that patients generally have a firm knowledge base of their disease with the predominant finding being that patients wish to be more informed with written information about their diagnosis and alternatives for treatment. While initially time consuming, completion of care plans had many benefits for clinicians; they prompted them to collect holistic information, engage in discussions to capture patient goals and document details about prognosis, treatment options and management of side-effects. Medical oncology care plans provide a sustainable method to provide clinicians a practical template to gather vital information and encourage patients to participate in the decision-making process for healthcare.

Administration of immune checkpoint inhibitors using teleoncology model of care in Far North Queensland: A multicenter review of safety outcomes.

2084 Background: The Teleoncology model of care, as developed and implemented across health services in Far North Queensland (Australia), improves access to specialist oncology services, including telehealth supervised administration of Oncology drugs for patients in rural/remote towns. There is limited published data regarding the safety of checkpoint inhibitor immunotherapy when it is administered via Teleoncology. Aim: Evaluate safety of immunotherapy administration via Teleoncology, including immune-related adverse events (irAE), treatment delays, hospital admissions and interhospital transfers, in comparison to a retrospective control population. Methods: Retrospective review of all patients treated with immunotherapy via Teleoncology as part of Cairns and Hinterland Hospital and Health Service (CHHHS) and the Townsville Teleoncology Network (TTN) between January 2015 and April 2019. A retrospective cohort treated at Townsville Cancer Centre over the same time period was used as a control group. Results: Fifty-one patients received a total of 624 cycles of immunotherapy (all single agent anti-PD-1/L-1) via Teleoncology. The control population included 142 patients who received 1697 cycles of immunotherapy. Baseline characteristics were well matched between groups. Compared to the control population, patients treated via telehealth did not have statistically significant differences in the rate of Grade 3+ irAE (13.7% v 8%), hospital admissions (13.7% v 7.4%) or protocol suspensions due to immune toxicity (16% v 10%). One patient with Grade 3+ irAE required interhospital transfer for investigation and management, which occurred within 24 hours of presentation to hospital. There were no treatment-related mortalities in either group. Conclusions: Checkpoint inhibitor immunotherapy can safely be delivered using the Teleoncology model of care in rural and remote centres. The incidence of toxicity for single agent immunotherapy was predictably low and not significantly different between groups, however the numbers in this retrospective study were small. The time to recognition and management of immune mediated toxicity in rural and remote centres is an important factor that was not assessed in this study and will be considered in future work.

Telehealth in radiation oncology at the Townsville Cancer Centre: Service evaluation and patient satisfaction

PurposeTelehealth (TH) in Radiation Oncology at Townsville Cancer Centre (TCC) was implemented in July 2011 to provide cancer care closer to home to the regional and rural population. The aim of this study was to describe the service use and patient satisfaction. Materials and methodsA retrospective audit of records was conducted for patients treated at TCC between July 2011 and December 2015. Data included patient demographics, diagnosis and treatment. Results of a patient satisfaction survey were summarised through descriptive statistics. ResultsA total of 1530 TH consultations were provided to 833 patients. 311 patient charts were audited (615 TH, 650 in-person, 151 phone consultations). Median distance from TCC to satellites was 327.3 km (21.6 to 1130.1). 71% were male and median age was 65 (23–94 years). Cancer diagnoses included prostate (32%), breast (12%) and head and neck (10%). 60% of patients underwent radiation therapy for curative intent, 22% palliative and 18% did not undergo treatment. 106 patients participated in the satisfaction survey (231 patients invited, response rate of 46%), with the overall positive response mainly attributed to advantages in travel and time savings. 54.7% of patients selected TH as their preference for future consultations, 34.9% indicated a mix of TH and in-person consultations, and only 1 patient (0.9%) indicating in-person only. ConclusionTH enables the delivery of radiation oncology consultations to rural and regional patients, with an overall high level of patient satisfaction. Patients welcomed the model for benefits of travel and time savings. Future directions include engaging with specialist, rural medical staff and patients to maximize access.

Enhancing Chemotherapy Capabilities in Rural Hospitals: Implementation of a Telechemotherapy Model (QReCS) in North Queensland, Australia.

The Queensland Remote Chemotherapy Supervision (QReCS) model enables rural nurses to administer chemotherapy in smaller rural towns under supervision by health professionals from larger centers using telehealth. Its implementation began in North Queensland, Australia (population, 650,000), in 2014 between two regional cancer centers (Townsville and Cairns as primary sites) and six rural sites (125 to 1,000 kilometers from primary sites). Our study examined the implementation processes, feasibility, and safety of this model. Details of implementation and patients' clinical details for the period of 2014 to 2016 for descriptive analysis were extracted from telechemotherapy project notes and oncology information systems of North Queensland, respectively. After a successful pilot study in Townsville Cancer Centre, statewide rural and cancer networks of Queensland Health, in collaboration with clinicians and managers across the state of Queensland, developed the QReCS model and a guide for operationalizing it. QReCS was implemented at six sites from 2014 to 2016. Main enablers across North Queensland included collaboration among clinicians and managers, availability of common electronic medical records, funding from Queensland Health, and installation of telehealth infrastructure by statewide telehealth services. Main barriers included turnover of senior management and nursing staff at two rural towns. Sixty-two patients received 327 cycles of low- to medium-risk chemotherapy agents. Rates of treatment delays, adverse events, and hospital admissions were similar to those in face-to-face care. Implementation of the QReCS model across a large geographic region is feasible with acceptable safety profiles. Leadership by and collaboration among clinicians and managers, adequacy of resources and common governance are key enablers.

Telehealth in radiation oncology: Service evaluation and patient satisfaction.

e18882Background: Telehealth (TH) in radiation oncology at Townsville Cancer Centre was implemented in July 2011. The service has grown to include regular TH radiation oncology new and review clini...

Clinical profile and treatment outcomes of advanced neuroendocrine tumours in rural and regional patients: a retrospective study from a regional cancer centre in North Queensland, Australia.

Neuroendocrine tumours (NET) arise from neuroendocrine cells, which are widely distributed throughout the body. However, diagnosing NET is difficult due to nonspecific symptoms and the paucity of experience among health professionals. This retrospective study was carried out to improve our understanding about NET. This knowledge can be used for optimal utilisation and distribution of limited resources. To study the clinical profile, treatment and survival outcomes for advanced NET patients in Australian regional and remote settings. We reviewed all adult patients who were diagnosed with NET between 1994 and 2012. Patients' data were extracted from electronic databases of The Townsville Cancer Centre. Remoteness was based on postcodes, with patients stratified as regional or rural North Queensland according to Australian Standard Geographical Classification (ASGC). Overall survival was studied using survival analysis. Data from 79 patients were included in the study. The median age at diagnosis was 60 years. A total of 48 patients (60.8%) was male and 31 (39.2%) female. The majority of the patients lived in rural areas (51, 64%) as compared to residing in regional areas (28, 36%). There were 34 deaths at the study cut-off point. Median overall survival of NET patients in rural areas is significantly less than those living in regional areas (1613 days vs. 2935 days, respectively), P = 0.03. Remoteness has an adverse impact on overall survival of NET patients. This outcome may be because of varied access to health services and/or lack of access to specialised scans and medical and surgical expertise.

Telehealth: a new opportunity to discuss smoking cessation with indigenous cancer patients and their families.

[Extract] Public health initiatives aimed at promoting the negative health impacts of smoking have led to decreases in smoking among non-indigenous populations; however, higher rates of smoking continue to be the leading cause of disease burden among indigenous populations throughout the developed world. For Aboriginal and Torres Strait Islander peoples (hereafter referred to as Indigenous Australians), the situation is dire with Indigenous Australians 1.9 times more likely to die of lung cancer Rates of smoking vary within and between Indigenous communities with significantly higher rates reported for Indigenous populations (41%) compared with non-Indigenous Australians (16%). Remoteness and younger age appear to be critical risk factors for higher rates of smoking among Indigenous Australians with rates as high as 62% reported for women aged 15 to 34 years in a remote community in North Queensland and 76% among men in a community in the Northern Territory.

Remote chemotherapy supervision model for rural cancer care: perspectives of health professionals.

Townsville Cancer Centre (TCC), a tertiary cancer centre in North Queensland, Australia, provides chemotherapy services to surrounding small rural towns using the Queensland Remote Chemotherapy Supervision model (QReCS). Under this model, selected chemotherapy regimens are administered in rural hospitals by rural based generalist doctors and nurses, under the supervision of TCC-based medical oncologists and chemotherapy competent nurses through videoconferencing. We sought to explore the perspectives of health professionals participating in QReCS. This qualitative study used semi-structured interviews with 19 participants, including nine nurses, eight doctors, one rural pharmacist and one administration officer. The interviews were recorded and transcribed. Transcripts were examined using iterative thematic analysis. Four major themes were identified from the data: (1) benefits of the model, (2) enablers of implementation, (3) operational requirements for optimal functioning and (4) disadvantages of the model. The reported benefits of the model were patient convenience, inter-professional communication across health district borders, expanded scope of practice, continuity of care and maintenance of patient safety and compliance with guidelines while delivering chemotherapy. Further improvements in the quality of training for rural nurses, coordination between urban and rural sites and between health professionals and documentation of clinical encounters would optimise the operation of the model. QReCS appears to provide many benefits to patients and health professionals and a framework for safe administration of chemotherapy in rural areas. Coordination of care, the quality of training for rural nurses as well as clinical documentation needs to improve to optimise the operation of the model.

Timely access to specialist medical oncology services closer to home for rural patients: experience from the Townsville Teleoncology Model.

Prior to 2009, the teleoncology model of the Townsville Cancer Centre (TCC) did not achieve its aims of equal waiting times for rural and urban patients and the provision of reliable, local acute cancer care. From 2007-2009, 60 new patients from Mt Isa travelled to TCC for their first consultation and their first dose of chemotherapy. Six of these patients required inter-hospital transfers and eight required urgent flights to attend outpatient clinics. Only 50% these rural patients (n = 30) were reviewed within one week of their referral, compared with 90% of Townsville patients. A descriptive study. TCC provides teleoncology services to 21 rural towns; the largest is Mt Isa, Qld. Specialist review of 90% of urgent cases within 24 hours, and 90% of non-urgent cases within one week of referral via videoconferencing. A 50% reduction in inpatient inter-hospital transfers from Mt Isa to Townsville. Employment of a half-time medical officer and a half-time cancer care coordinator, and implementation of new policies. Between 2009 and 2011, TCC provided cancer care to 70 new patients from Mt Isa. Of these new patients, 93% (65/70) were seen within one week of referral. All 17 patients requiring urgent reviews were seen within 24 hours of referral and managed locally thus eliminating the need for inpatient inter-hospital transfers. Provision of timely acute cancer care closer to home requires an increase in the rural case complexity and human resources.

A tele-oncology model replacing face-to-face specialist cancer care: perspectives of patients in North Queensland

We explored the experiences of patients using the Townsville Tele-oncology clinic, where most patients are no longer seen face-to-face. All medical oncology patients who received services via telehealth at the Townsville Cancer Centre in 2012 were invited to participate in an interview. None refused. Thirty two patients were interviewed by telephone and three via videoconference at their local health service facility. Data analysis identified five major themes (quality of the consultation; communication and relationships; familiarity with technology and initial fears; local services and support; and lack of coordination of services between the local rural hospital and the major regional hospital) and each major theme included a number of sub-themes. Most patients interviewed (69%) had not seen their oncology specialist face-to-face, but 86% of them found the video-consultation to be of high quality and were extremely satisfied with the interaction. The acceptance of teleconsultation appeared to be linked to the patients' trust with their local health system and staff. Overall, the tele-oncology model that replaced face-to-face care in North Queensland was accepted and welcomed by patients.

Cost savings from a telemedicine model of care in northern Queensland, Australia

To conduct a cost analysis of a telemedicine model for cancer care (teleoncology) in northern Queensland, Australia, compared with the usual model of care from the perspective of the Townsville and other participating hospital and health services. Retrospective cost-savings analysis; and a one-way sensitivity analysis performed to test the robustness of findings in net savings. Records of all patients managed by means of teleoncology at the Townsville Cancer Centre (TCC) and its six rural satellite centres in northern Queensland, Australia between 1March 2007and 30November 2011. Costs for set-up and staffing to manage the service, and savings from avoidance of travel expenses for specialist oncologists, patients and their escorts, and for aeromedical retrievals. There were 605teleoncology consultations with 147patients over 56months, at a total cost of $442276. The cost for project establishment was $36000, equipment/maintenance was $143271, and staff was $261520. The estimated travel expense avoided was $762394; this figure included the costs of travel for patients and escorts of $658760, aeromedical retrievals of $52400and travel for specialists of $47634, as well as an estimate of accommodation costs for a proportion of patients of $3600. This resulted in a net saving of $320118. Costs would have to increase by 72% to negate the savings. The teleoncology model of care at the TCC resulted in net savings, mainly due to avoidance of travel costs. Such savings could be redirected to enhancing rural resources and service capabilities. This teleoncology model is applicable to geographically distant areas requiring lengthy travel.

Is intensive chemotherapy safe for rural cancer patients?

To provide equality of cancer care to rural patients, Townsville Cancer Centre administers intensive chemotherapy regimens to rural patients with node-positive breast and metastatic colorectal cancers at the same doses as urban patients. Side-effects were usually managed by rural general practitioners locally. The aim is to determine the safety of this practice by comparing the profile of serious adverse events and dose intensities between urban and rural patients at the Townsville Cancer Centre. A retrospective audit was conducted in patients with metastatic colorectal and node-positive breast cancers during a 24-month period. Fisher's exact test was used for analysis. Rurality was determined as per rural, remote and metropolitan classification. Of the 121 patients included, 70 and 51 patients had breast and colon cancers respectively. The urban versus rural patient split among all patients, breast and colorectal cancer subgroups was 68 versus 53, 43 versus 27 and 25 versus 26 respectively. A total of 421 cycles was given with dose intensity of >95% for breast cancer in both groups (P > 0.05). Rate of febrile neutropenia was 9.3% versus 7.4% (P = 0.56). For XELOX, rate of diarrhoea was 20% versus 19% (P = 0.66) and rate of vomiting was 20% versus 11% (P = 0.11). Only two patients were transferred to Townsville for admission. No toxic death occurred in either group. It appears safe to administer intensive chemotherapy regimens at standard doses to rural patients without increased morbidity or mortality. Support for general practitioners through phone or videoconferencing may reduce the safety concerns.

Teleoncology for Indigenous patients: The responses of patients and health workers

Townsville Cancer Centre provides video-consultation (VC) services to patients in rural/remote regions of North Queensland in order to improve access to specialist cancer care. The experience and responses of indigenous patients using this service have not been studied. Our objective is to assess the level of satisfaction and the responses of Indigenous patients, their families and health workers (HWs) to VC and such teleoncology service. Descriptive study, using semistructured interviews. Tertiary referral centre (Townsville Cancer Centre) and various rural and remote towns in Queensland. Satisfaction levels of Indigenous patients, their family members and Indigenous HWs with various aspects of the teleoncology service. Our evaluation suggests that teleoncology is an acceptable model of care for Indigenous patients, with high levels of satisfaction expressed from patients, families and HWs. Health professionals involved with providing this service need to be adaptive to the needs of individual patients and local communities in order to provide culturally appropriate care. Formal skills training for staff, effective communication between specialist and local HWs, and informed consent procedures are essential to maintain safety of practices. Strategies for change are: • Mandatory informed consent procedure for all patients offered with VC. • Formalised competency training for staff in skills essential to maintain safe practices in teleoncology. • Clear clinical documentation to facilitate improved communication in patient management between medical staff at main centre and distant sites. • Further efforts in promotion, education and support for staff to participate in telemedicine.

Telemedicine for rural cancer care in North Queensland: Bringing cancer care home

To describe the use of telemedicine in cancer care (teleoncology model of care) for rural patients in North Queensland. This is a descriptive study. Data on demographical and clinical factors were retrieved from the teleoncology database of Townsville Hospital and review of medical records for the period between May 2007 and May 2011. The medical oncologists at the Townsville Cancer Centre, a regional cancer centre in North Queensland, have been providing their services to rural hospitals in Townsville and Mt Isa districts via videoconferencing since 2007. Cancer care delivery to rural sites via Townsville teleoncology model. The ability of the teleoncology model to provide the following services to rural towns: (i) specialist consultations; (ii) urgent specialist medical care; (iii) care for Indigenous patients; and (iv) remote supervision of chemotherapy administration. Between May 2007 and May 2011, 158 patients from 18 rural towns received a total of 745 consultations. Ten of these patients were consulted urgently and treatment plans initiated locally, avoiding interhospital transfers. Eighteen Indigenous patients received consultative services, being accompanied by more than four to six family members. Eighty-three patients received a range of intravenous and oral chemotherapy regimens in Mt Isa and oral agents in other towns through remote supervision by medical oncologists from Townsville. Teleoncology model of care allows rural and Indigenous cancer patients to receive specialist consultations and chemotherapy treatments closer to home, thus minimising the access difficulties faced by the rural sector.

Poster Abstracts

Background: The Townsville Cancer Centre (TCC) has been delivering its medical oncology services closer to home for patients from 19 rural centres via teleoncology since 2007. Patients are satisfied with this model of care. The aim is to describe the services extended to rural patients and the resource improvements enjoyed by rural hospitals as a result of teleoncology over this period. Methods: Data for patients treated via teleoncology from 1st April 2007 to 31st March 2012 was extracted from the oncology information system of TCC. Demographic details and type of services provided are presented descriptively. Results: A total of 170 patients were seen in 800 consultations over 60 months. Median age was 58 years (20–89), males 46% and females 54%. 25 patients were from remote indigenous communities. Most common cancer types were breast (37%), colorectal (21%) and lung (22%). A total of 87 patients received chemotherapy in Mount Isa, supervised remotely from Townsville via video conference with curative intent in 30% and palliative intent in the rest. Examples of chemotherapy regimens included docetaxel, doxorubicin and cyclophosphamide (TAC), bleomycin, etoposide and cisplatin (BEP), methotreaxte and ifosfamide infusion. 15 patients were seen urgently and appropriate treatment initiated within 24 hours in Mount Isa, thus avoiding inter hospital transfer. Six admitted patients were seen on regular ward rounds. Severe toxicities included one death from pneumonia, one stroke and one resuscitated cardiac arrest. By improving the resources in Mount Isa hospital to accommodate these services, numbers of oncology specific medical and allied health practitioners and service capability have improved. Conclusion: Teleoncology model can enhance rural service capabilities and health resources so that comprehensive medical oncology services can be sustainably provided to rural areas by remote supervision.

Medical oncology clinics through videoconferencing: an acceptable telehealth model for rural patients and health workers

Since 2007, Townsville Cancer Centre (Queensland, Australia) has provided routine and urgent medical oncology services to rural and remote communities through videoconferencing. At remote sites, patients were accompanied by doctors and other health workers. The aim of this study was to describe satisfaction of patients and rural health workers with this model of teleoncology. Between May 2007 and June 2010, 55 videoconferencing patients were invited to participate in a questionnaire-based telephone survey after informed consent. The survey included responses to 16 satisfaction statements using a 5-point Likert scale. Perspectives of health workers involved were recorded using open-ended questions on six themes related to telehealth. Among the 50 participating cancer patients, median age was 56 years (range 28-83). Seventy-six per cent of patients thought specialist physical examination was important despite local doctors performing it. Seventy-six per cent of patients felt the presence of accompanying local health workers was not important. Seventy-eight per cent of patients preferred to be seen in Mt Isa for the first consultation through videoconferencing than travelling to Townsville. More than 80% of patients were in agreement with the rest of the satisfaction statements. Ninety-six per cent of patients were in agreement with the question relating to overall satisfaction. Eighteen health workers participated and their responses and attitudes were favourable towards telehealth. Satisfaction with this model of care was proven to be high among both patients and health workers. Benefits perceived included effective communication between patients and specialists, reduced travel time and money expenditure, and superior specialist support for rural health workers.

Efficacy and tolerability of weekly low‐dose cisplatin concurrent with radiotherapy in head and neck cancer patients

In this retrospective analysis, we describe the efficacy and tolerability of weekly cisplatin 40 mg/m(2) used in concurrent chemoradiation of head and neck cancer at the Townsville Cancer Centre. Review of medical records of patients who received radical chemoradiotherapy for head and neck cancer at Townsville Cancer Centre from 2003 to 2009. In all 102 patients were analysed, 62 of whom had definitive chemoradiation and the remainder adjuvant chemoradiotherapy. Median follow up was 20.1 months (range 5-86 months). Overall 68.6% of patients received 5 weeks or more of planned chemotherapy. Radiotherapy interruptions occurred in four (6.4%) patients. The rate of grade 3-4 adverse events was 51% including neutropenia (18.6%), mucositis (21.8%) and dysphagia (12.9%) and 30.7% of patients needed hospital admission to manage toxicities. For definitive and adjuvant groups, estimated 3-year survival was 64.5 and 71.5%, respectively, and estimated 3-year disease-specific survival rates were 70.3 and 81.6%, respectively. The 3-year overall survival for patients who received five or more cycles of chemotherapy was 75.2%, compared to 52.6% for those receiving fewer than five cycles (P = 0.018). Despite this is being a small retrospective study, survival figures and toxicity profiles of low dose weekly cisplatin are comparable to historical controls using high-dose regimens, hence justifying our approach. In addition, radiotherapy interruptions are minimized and cisplatin is easy to administer in outpatient settings. Future three-arm studies could include this regimen as the basis of treatment combined with targeted therapies.

Medical oncology services in cyber space: Benefits of the Townsville teleoncology project.

e16545 Background: Current models of rural outreach cancer care are inadequate since patients and specialists spend significant amount of time in costly long distance travels for consultations and treatment. Clinics conducted using videoconferencing technology eliminates unnecessary travel while providing subspecialist services closer to rural homes. Townsville Cancer Centre (TCC) in Queensland, Australia provides all its medical oncology services including supervision of chemotherapy delivery, in patient consultations and ward rounds exclusively on videoconferencing for most rural cancer patients in their health districts. Distances between TCC and rural towns range from 400 to 1200 km. Overall clinic model and patient satisfaction are described elsewhere. Clinics are run weekly, ward rounds and in patient consultations are conducted on demand. Aim of this report is to describe the benefits of our model of care. Methods: Data on clinics conducted between May 2007 and December 2010 was extracted from the oncology information system of the TCC. Results: A Total of 150 patients were reviewed in 609 consultations in 44 months. Median age was 58 (20-86) and males were 46% and females 54%. 24 patients were from indigenous communities. Last 77 patients were cared for without seeing in person. Most common cancer types were breast (37%), colorectal (21%) and lung (22%). Total of 81 patients received a total of 431 cycles of chemotherapy. Examples of chemotherapy regimens include TAC, BEP, FOLFOX, methotrexate infusion etc. One patient died of severe pneumonia after one cycle of capeciatbine, one patient suffered a stroke after 4 cycles of EOX and one suffered non fatal cardiac arrest after herceptin. Other side effects and admission rates were similar to TCC figures. 10 patients were seen urgently and received urgent chemotherapy, thus avoiding transfer to TCC. 6 admitted patients were seen on regular ward rounds during their in patient admission. Conclusions: Provision of comprehensive medical oncology services via videoconferencing is feasible and is a safe and efficient model of care for rural, remote and indigenous patients of North Queensland. Given its many benefits, our model could become part of standard practice.

Efficacy of weekly cisplatin 40mg/m2 in definitive and adjuvant chemoradiation of head and neck cancer: A retrospective analysis.

e16039 Background: When chemotherapy is needed with radiotherapy for head and neck cancers, 3-weekly high dose cisplatin is the regimen that has been used in large randomised trials. Difficulties with this regimen include high rates of toxicities and need for overnight admissions for hydration. Weekly cisplatin has been used in our institute for concurrent chemo radiation (CRT) of head and neck cancers to reduce toxicity and improve compliance. Aim of this study is to examine the efficacy of this approach. Methods: Retrospective review of medical records was undertaken on patients who received radical chemo radiation with weekly cisplatin 40mg/m2 at Townsville Cancer Centre from 2003 to 2009. Statistical analysis was performed using SPSS- version17 and survival probabilities were estimated using the Kaplan-Meier method. Results: Out of the total 102 patients who were eligible for analysis, 62 received definitive CRT and 40 received adjuvant CRT. Median follow-up was 20.1 months (range 5 to 86 months).37.2 % of patients got all the 6 planned doses of cisplatin while 68.6% received at least 5 doses. Only 4 (6.4%) patients had interruption of radiotherapy. For definitive CRT group and adjuvant CRT group, estimated 3-year overall survival was 64.5% (95% CI 51 to 78) and 71.5% (95% CI 53 to 90), respectively. The estimated 3-year disease-specific survival in definitive and adjuvant CRT groups were 70.3 % (95% CI 57 to 84) and 81.6% (95% CI 69 to 94), respectively. The 3-year survival for patients who got 5 or more cycles of chemotherapy was 75.2% (95% CI 63 to 88) compared to 52.6% (95% CI 33 to 72) for those who got less than 5 cycles ( p value =0.018). Conclusions: Despite this being a small retrospective study, survival figures and toxicity profiles of low dose weekly cisplatin are comparable to historical controls using high dose regimens. In addition, radiotherapy interruptions are minimised and it is easy to administer in out patient setting.