“I can’t thank you enough for your help.”
This gratitude from a cancer survivor surprises me since I recall doing little of the sort.
Some years ago, the young professional was in the throes of seeing multiple specialists, their advice strewn like confetti in her ordered life. Under pressure, she was calm and methodical. What impressed me most, however, were her astute questions. Why did she need such a major operation? How did gene testing matter? How much chemotherapy was enough? How could her voice be heard?
Every doctor knows to avoid a gratuitous second opinion without reviewing the evidence and, importantly, the person. Quietly, I found the plan aggressive and ill-explained but I simply urged her to nail down answers to her questions that were not merely academic but highly consequential. Then I crossed my fingers.
Now, I uncross them as she reports having undergone a much smaller procedure thanks to her persistence. I know all too well the potential damage she escaped through being educated, empowered and unafraid to challenge her doctors, which reminds me of my average patient who is so disadvantaged, disempowered and frazzled that there is a heavy reliance on “the system” to get things right.
In one of the world’s richest countries, every cancer patient should expect equitable care delivered by excellent clinicians informed by the best evidence. But the further patients live from a metropolitan cancer centre the more likely they are to die within five years of their diagnosis. Add to this the disparities in outcomes due to language, Indigenous and minority status and the lived reality pinches.
How does a large multicultural country with many remote communities, few comprehensive cancer centres, and poor health literacy level the ground?
The recently released Australian Cancer Plan is a good start.
By way of disclosure, I am on the advisory board of Cancer Australia, the government body that designed the plan.
Underpinning the plan are six strategic objectives. Broadly, they cover patient experience (from early detection to dying well), workforce capacity (a capable, coordinated and integrated system) and modern infrastructure (harnessing technology, digital data and artificial intelligence). Ambitions, goals and actions are outlined for the next two, five and 10 years.
The national cancer plan is brimming with good ideas but here are my top three picks.
Optimal care pathways
If you are diagnosed with cancer, a straightforward question is: Am I getting the best treatment? For those treating your cancer, the corollary is: Am I offering the best treatment?
No one expects the patient to know the fine interplay of science and art that constitutes a treatment recommendation, but few people recognise that the doctors making those recommendations also need help keeping up with the rapid advances in medicine.
Cancer is not one but many different diseases depending on its molecular signature.
(This is one reason why your oncologist may not be interested in your neighbour with the “exact same” cancer receiving a different treatment.)
Every sophisticated diagnosis requires an increasingly nuanced approach. In oncology, “routine” becomes “obsolete” in a flash. Since I qualified, the FDA has approved more than 600 cancer therapies. No intention or discipline can help doctors absorb all the information we need to know.
Optimal care pathways, provided they are living documents, offer a way forward for both parties by outlining best practice pertaining to all stages of the cancer continuum.
Every cancer patient should be aware of this (free) resource because it could be the best way to focus doctor-patient communication.
A strong workforce
The plan imagines a “strong, engaged and capable workforce” to tackle the rising incidence of cancer, the growing complexity of care and the happy fact of survivorship. This workforce would be expert, diverse, multilingual and culturally appropriate. I love the ambition but worry about its fruition if the lobbies representing doctors and non-doctors keep quibbling.
The cancer centre of my dreams teems with nurse practitioners and navigators who transform my life and, crucially, that of my patients. Present as well would be physiotherapists, occupational therapists, pharmacists, social workers, psychologists and chaplains who view illness from different angles.
In my dream, the doctors are happier and more productive because they do some things well rather than do many things poorly or not at all.
Amid competing concerns in any health budget, achieving genuine multidisciplinary care will require cajoling, cooperation and compromise.
Technological innovation
The Australian Cancer Plan heralds an era of “omics” (as in genomics), digital sophistication and artificial intelligence. We must not gloss over this as futuristic.
New platforms will help more patients access precision medicine, a key to better outcomes.
Indeed, existing technology can gauge my patients’ evolving condition and help me keep them away from emergency.
Imagine being nudged to have better conversations about serious illness, reduce over-investigation, and recognise that for certain patients, dementia trumps a cancer diagnosis.
Cancer professionals are eager to do better but absent an advanced and secure system to harness information, I fear our care will remain piecemeal. This is why investment in technology is a must.
By age 85, one in two of us will receive a cancer diagnosis and the rest will feel the impact. If you care about cancer, you should care about a plan that serves every affected person. I ask you to read it, use it and share it.
Meanwhile, if anyone is listening, please fix my public hospital printer so it works every single day and prints at my desk alone. I promise it will improve lives instantly, no 10-year plan needed.
Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death
