Getting less than the best cancer treatment

Updated July 29, 2010 07:22:00

Researchers found the quality of the radiation treatment patients received made a huge difference to their outcomes and survival. (ABC News: Francis Tapim)

When it comes to cancer treatment, most patients would hope to get the latest medications, delivered in line with the world's best practice. But new research from Melbourne's Peter MacCallum Cancer Centre suggests that's not happening. In fact, it's the opposite in many cases.

The researchers took part in a massive study of 853 patients from 16 countries, including Australia. All patients had head and neck cancers. Researchers wanted to compare patients who received chemotherapy and radiation treatment with those given both treatments and a new drug.

To assess the impact of the new drug, they had to make sure all patients were getting good quality radiation treatment.

What they found surprised them. They discovered it was the quality of the radiation treatment that patients received which made a huge difference to their outcomes and survival. Study author Professor Lester Peters found that deviating from the guidelines when giving radiation had a major impact.

"More than one quarter of 'cancer treatment' plans submitted didn't comply with protocols. Those who received inferior radiotherapy had a markedly poorer outcome," he said. In fact, almost 100 patients had treatment plans with significant deficiencies that "would have a likely impact on tumour control".

Even when flaws in treatment plans were pointed out, none of the changes were made which would bring it into line with world's best practice.

Researchers could even quantify the effect, saying that patients who were not getting treatment in line with the guidelines only had a 50 per cent survival rate compared to 70 per cent in the rest of the population. Getting proper radiation made much more difference than the new drug they were testing. The study found impact of poor radiotherapy greatly exceeded the anticipated benefits of concurrent chemotherapy.

So why aren't some cancer patients getting treatment in line with guidelines? The authors found that the size of the cancer centre was crucial.

Centres treating small numbers of patients were the major source of problems, according to author Associate Professor Danny Rischin. Patients in large hospitals had a 5 per cent likelihood of getting poor treatment. In centres with smaller numbers, the rate was as high as almost 30 per cent.

So is the answer to treat all cancer patients in larger centres? It's more complicated than that as many patients want to have cancer treatment in a smaller centre, close to home, rather than travel to a large facility. The nature of radiation treatment means that people need to go the hospital every day for weeks to complete their treatment, so convenience does become a concern for patients. Patient demand has seen the growth of many smaller cancer centres around Australia.

Getting the smaller centres in line with world's best practice is the key. Professor Bryan Burmeister is the president of the Trans-Tasman Radiation Oncology Group. He says if cancer centres want to do complex treatments, they need to be able to show that they can do it safely and effectively so that patients do not miss out.

That way, the convenience of having a cancer centre in your suburb doesn't mean that you are going to get less that the best treatment.

Sophie Scott is the ABC's national medical reporter.

Tags: health, diseases-and-disorders, cancer, australia

First posted July 29, 2010 07:14:00

Comments (16)

Comments for this story are closed, but you can still have your say.

CUTEYOUNGCHIC:

29 Jul 2010 8:52:51am

There's often a very tiny profit margin after expenses, in any small service-providing environment. Could this be the problem?
Ask Clinical Nutritionists (no, not dieticians) about cancer, and treatments.

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Michelle:

29 Jul 2010 9:50:45am

Having first hand experience of radiation, oncology and a large regional hospital I can say it's a micracle that people are even treated at all.

It's only the dedication of good staff that gets people through. Hospital systems and procedures are shambolic. Words cannot describe just how bad they are and that is terrifying.

Add to that the fact that equipment and infrastructure is below any measure of acceptable - people who should be starting agressive treatment same day are instead being left to wait weeks and months.

It's systemic failure which is endemic throughout the health system. I have two parents both of whom have been very unwell with various ailments over the years. On more than one occasion I have had stand up arguments with incompetent bullying administrators and some doctors. Unfortunantly I have had to be not just a caring relative but my parents advocate as well. That just shouldn't have to be the case. When someone you love is in pain and needs help, the last thing a relative should have to be do doing is fighting a system in crisis.

I have had to walk away from my frightened mother's bedside to have an argument in the hall with a doctor. I can't begin to tell you what it did to me to have to walk away from her for even those few minutes. (As it turned out, that drs opinion was wrong and we got the new dr I fought to get).

I am at the point that I will now take photos of bed charts so I have a record. I have cried while doing it because I just plain shouldn't have to feel such a lack of confidence in the system. To feel like that, and yet still leave someone you love behind in that situation is to be torn in two. I hope they will get better care than if I took them home, but it's a hope - not a certainty.

I hope that by being assertive and involved in their care that I send a message to the incompetants that may be around them to watch their step. At the same time I worry that the good staff may be offended.

That I have to behave like this to try and safeguard my loved ones is the greatest saddness of my life. I would love to just be able to be there for my parents and focus on that. Instead I have to be some sort of watchdog against an intangible system of failure.

Rant over.

Obviously touched a nerve.

I loath every politician who has allowed our health system to degenerate to this joke.

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- KM:
  
  29 Jul 2010 1:43:49pm
  
  I'm so sorry to hear your experiences Michelle. Sadly, they confirm my own.
  I've been through it twice before and now is my third time. Each time except this latest, I have had to be my own advocate.
  The last time, the hospital lost all my records and when they 'found' them, all we got were a bunch of lies full of my forged signature. (Plus the wrong dates)
  
  This time, I carry an iphone with me to record everything that is said and done, to cover myself.
  
  It is so difficult to go through the physical and finacial difficulties of a terrible illness, but to also have to yell, scream and have emotional distrust of so much of the system is truly terrifying.
  Yep, guess it hit a nerve in me also.
  
  Thankyou to all the wonderful staff who do show compassion (usually the nurses in my experience) in such difficult circumstances.
  Our politicians have really let us down. Reminds me off that article this website posted a while ago about how the health ministry office works.....
  
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  - Michelle:
    
    29 Jul 2010 2:57:46pm
    
    Thank you KM, and I am likewise sorry to hear of your experiences.
    
    The iphone is a great idea and I will do that as well now.
    
    I wish there was support group for people like us, so we can swap ideas and just try to help each other out a bit. I'm betting getting members wouldn't be a problem, unfortunantly.
    
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- Grump:
  
  29 Jul 2010 6:19:31pm
  
  Having been in a similar situation as a carer for my late partner
  I encountered lies & cover-ups from incompetent hospital administration when questioning regular errors in treatment.
  The whole NSW health system is a shambles.
  
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Wagner:

29 Jul 2010 10:10:43am

Amazing how a Government can allow cancer treatment procedures to fall behind and yet wasete billions of dollars on rorted BER and "Green" schemes.

I recall Kevin Rudd wanting to rip millions out of chemotherapy funding back in 2009 too...absoutley appalling practice.

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- Michelle:
  
  29 Jul 2010 6:44:01pm
  
  I recall how the previous Coalition gov had 11yrs to do something about it and failed totally.
  
  I recall that Rudd has been the only pollitician in the past DECADE to do anything to change it.
  
  I wouldn't say the Coallition has anything to be proud of, in fact, given the time they had to address the matter, I'd say they ought to be ashamed.
  
  They have nothing but my contempt for failing to address it.
  
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Francesca:

29 Jul 2010 10:45:32am

The main problem is oncology treatment is always changing, keeping up to date is a very difficult thing to do. As a medical student we are pretty much told not to bother learning the treatment protocols because by the time we graduate (2 years) they will be completely wrong. Further the more specialists = the more fine their knowledge is.

It is unfair to compare a tertiary hospital to a smaller regional one. Tertiary hospitals are filled with the brightest minds in the country, they have more money, more funds and doctors who conduct research on a regular basis. The tertiary hospitals are often the ones conducting the research which is changing the protocols, so naturally they have a vested interest in keeping on top of the latest protocols.

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azi:

29 Jul 2010 12:18:17pm

Medical guidelines are just that - guidelines. They are not policy or protocol. They also change regularly, as other commenters here have stated.

Various medical organizations have expressed concerns about the proliferation of health care guidelines and the difficulty health professionals face with keeping updated. They could do with extra support in keeping up with, and implementing, best practice guidelines. Where should that support come from? Perhaps that's the million dollar question.

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gerard1:

29 Jul 2010 12:33:02pm

As a resident of the Illawarra NSW and having a wife with a chronic illness, I can say that the issues pointed out here with cancer treatment are more widespread in that they cover most treatments and conditions.
I had a condition that was later diagnosed as pericarditis, a potentially fatal condition and also very painful. Yet in the ER of a hospital in the Illawarra, I found that the attending doctor was having a joke at my expense with his colleague and in the end after 16 hours, he claimed there was nothing wrong with me and he was sending me home with a prescription for Panadol.
Just an example as there is not enough room or time for me to list incident after incident with the hospital system and as I pointed out earlier, this was potentially fatal.

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- Michelle:
  
  29 Jul 2010 2:51:24pm
  
  Gerard, I am so sorry for what you went through. My father had the same condition, same outcome too, sent home with panadol and a moronic dr who accused him of malingering.
  
  I saw red that day and came as close as I have ever been to slapping that dr. The insult of a pretenious little upstart know-it all telling a man who been thorugh more suffering in his life than that little b* will ever know that he was just faking it for attention.
  
  All I can say to you is believe in yourself, don't be intimidated and continue to stand your ground.
  
  I wish you strength, good health and good doctors!
  
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CountryVic:

29 Jul 2010 1:05:41pm

I must take issue with the repeated reference to "convenience" as the reason there are smaller cancer centres and the fairly snide conclusion about suburban centres, again for "convenience." I live 2 1/2 hours from Melbourne. For cancer patients in my area to travel to Melbourne every day for weeks is not merely inconvenient. First there is the obvious financial cost of travel. Then, if the patient is unwell, pretty likely in the circumstances, it means a second person doing the driving or helping on the train. Instead of cancer treatment being an hour a day it becomes the whole day, or for many, whole weeks away from home with all the costs of motels, eating out and no opportunity to earn income.

There is ample evidence that country people have poorer cancer outcomes than city people. Access is not merely convenience. If the major teaching hospitals in the city want to do something really useful to improve cancer outcomes outside their well-resourced centres they could start by helping country centres rather than rubbishing them.

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Cambrian:

29 Jul 2010 2:52:32pm

This article states the solution then goes on to negate it quite spectacularly. The way to get the best treatment outcomes is to have large multidisciplinary centres in the metropolitan centres,where the population is aggregated. Every one knows this. It applies not just to cancer treatment it applies to cleft palate and children's cardiac surgery, and it applies to neurosurgery too. These are just examples. The British NHS for all its faults has mandated this. The Radcliffe Hospital in Oxford has recently been told to close its childrens cardiac surgery unit so patients can be treated at larger units where the surgeons get more practice at doing the less common hard operations resulting in better operative outcomes. The same with cleft palate. They analysed their data and the surgical outcomes were better in the larger units doing more cases each year. So, they closed the smaller units and sent the patients to the remaining larger units which produced the best results. The problem is that the everyone wants all hospital with all bells and whistles on their doorstep regardless of cost and regardless of the fact that it will only treat one or two uncommon cases per annum. In short you do not build a cardiac surgical centre in Burke. The trouble is the politicians lack the balls to tell the electorate this. Not only this but the state- federal division of funding and responsibility prevents rational planning of services. For example, Canberra should be the regional centre for NSW down to the Victorian border and out west to the SA border. This is not going to happen, because of the state -territory divide and because of petty local political considerations. They cannot even run Canberra Hospital and Queanbeyan Hospita in a co-ordinated fashion because of the state territory divide. The solution to patients having to travel is to build and properly fund self contained, one or two bed units where rural patients and their relatives can stay overnight whilst having their chemotherapy or radiotherapy. This is not really rocket science. Just good public policy based on sound principles that everyone should know about. This is why the medical and nursing professions supported Rudds hospital reforms that have been comprehensively white anted by the state politicians and their respective bureaucracies.

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Jeremy:

29 Jul 2010 4:41:36pm

My mother was diagnosed with cancer and given an agressive chemo treatment. The hospital could even get that right and gave her the wrong protocol. Getting her into hospital and then sending her home again.

Then she got a call saying she needed emergency hip surgery to pin a fracture. They got her in to prep for surgery and waited about 6 hours for the orthopaedic surgeon to come and tell her that on a second glance that she was ok and didn't need surgery.

All this stress made her 11 short weeks of life after diagnosis unbearable. Our hospitals are hopelessly incompetent and inefficient. I hope I never get sick.

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fhfs:

29 Jul 2010 5:00:52pm

Mine is a minor problem compared to others I have read about here. Mine is simply that my oncologist on 5 separate occasions has recommended I have MRI's and on each occasion neither Medicare nor my private health insurer cover any of the expense - they say it is not the preferred treatment for my cancer, yet my specialist says he wouldn't ask for it if it were not necessary. Result I am now several thousand dollars out of pocket. I have paid private health cover at the top rate and all of my raxes for over 40 years - so be it.

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Diana:

29 Jul 2010 6:23:07pm

Been covered by a private benefit should cover you for all outstanding costs involved with what ever treatment is required. But not so I know a lady who was out of pocket by $10,000- although she did manage to receive some benefits back from her private fund. I asked her what would happen if you didn't have any private health fund- answer was you'd have to go to Brisbane- go public. By then you'd probably be dead waiting on treatment. So much for government policy about Australians must have private health funds.

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Getting less than the best cancer treatment

Comments (16)

CUTEYOUNGCHIC:

Michelle:

KM:

Michelle:

Grump:

Wagner:

Michelle:

Francesca:

azi:

gerard1:

Michelle:

CountryVic:

Cambrian:

Jeremy:

fhfs:

Diana:

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