Cancer survivors deserve better follow-up care, says specialist cancer nurse Professor Raymond Chan from Flinders University. The standard way of caring for cancer survivors after they finish treatment is for hospitals to ask them to come back to cancer care clinics. But Ray says this follow-up care does not meet patient needs:
'The cancer centre is busy. At each appointment the cancer survivor waits for a long time to see the doctor. Because they finished their treatment, they may see a junior doctor The doctor checks their blood test results and says the cancer has not come back. That's the end of the appointment.
'Let's say the hospital treated the patient for prostate cancer. He could be losing muscle mass and have heart problems, erectile dysfunction and depression because of his cancer treatment. As he walks out of the clinic he thinks "no one has cared about my health problems."
'The cancer specialists at the hospital don't have time to treat these problems. And they are not the right people to give all the care the man needs,' Ray explains.
A multi-disciplinary team approach
Ray says a multi-disciplinary team approach could give better care. 'GPs and nurses could deliver some of the follow-up care for cancer survivors. But they often don't get enough information on their patients from the cancer centre. Therefore, they haven't been empowered to deliver this sort of care.'
Ray's solution is to create a nurse-led clinic. When a patient finishes their cancer treatment, they will have an appointment at the clinic with a specialist cancer nurse. The nurse will create a plan to meet their ongoing health care needs and coordinate this care between the hospital and their GP. This process empowers the patient to be in the driver's seat by partnering with their health professionals.
A case conference for each patient
The first step in the care plan is for the specialist cancer nurse to hold a case conference with the patient's GP and practice nurse. During the case conference the cancer nurse will explain the patient's specialised needs from their cancer treatment. They will recommend how to care for the patient and what symptoms the GP should escalate back to the hospital. The case conference also gives the GP a chance to clarify what care to give and why. The GP can negotiate which care they can give and what the hospital should give.
Alternating follow-up appointments
Another aim of the case conference is to arrange for cancer survivors to see their cancer specialist and their GP in alternating follow-up appointments. This approach allows the doctors to share responsibility for the survivor's follow-up care.
The shared care trial
Ray is trialling nurse-led shared care for prostate cancer survivors, supported by $1.63 million from the MRFF.
One group of prostate cancer survivors is receiving shared care and another group is receiving standard care. Ray is collecting data to see if survivors who receive shared care have better quality care and a better quality of life.
Ray will also look at data from the Pharmaceutical Benefits Scheme and the Medicare Benefits Scheme. This will show him which survivors receive more medicine and health care services.
Assessing the costs of reform
Health economist Professor Louisa Gordon, from QIMR Berghofer, is in Ray's research team. Her role is to analyse the data Ray collects. This allows her to assess the costs and quality of life benefits of shared care.
'I will be able to compare the costs and outcomes for survivors receiving shared care with those for survivors who receive standard care,' Louisa says.
Louisa uses the measure of quality-adjusted life years (QALYs) to compare outcomes for the two groups. QALYs represent a person's remaining life in years adjusted by the quality of that time. Louisa expects patients receiving shared care will gain more QALYs.
'Evaluating the extra cost of shared care per QALY gained allows us to compare this ratio with other Australian healthcare system interventions. This shows us if it is cost effective and good value for money,' Louisa says.
Activating health systems change on a large scale
Ray is leading similar trials for other types of cancer, including another MRFF funded trial for patients with neuroendocrine tumours. Funding for all these trials adds up to more than $10 million. Ray hopes the cumulative effect of the trials will activate health system change on a large scale.
'My hope is that after a few years, enough GPs participate in the shared care model whereby it will become the norm for them. They will see the hospitals communicating enough so they know what to do.'
Ray also hopes evidence from the trials will lead to policy change. 'Then you are influencing the system at a larger level than just one GP practice at a time. This is my career vision and I hope I can achieve it in ten years so I can move on to other dreams.'
