Australias Radiation Oncology Tripartite Committee (ROTC) recently released an extensive audit of radiation oncology services, hoping to make purported shortfalls in radiation oncology across Australia a campaign issue in the countrys November elections. Although the report was widely discussed within Australiawith broad consensus that the problems are realagreement on solutions is not in sight.
Issued as a strategic plan by the profession, the report flagged problems in waiting lists for radiation therapy, staff shortages, inattention to training, and a lack of planning and coordination at the federal and state level. An "immediate crisis" exists in the radiation therapy sector, charged the panel, recommending adoption of a national strategic plan to ensure a sustainable future.
The strategic plan was put together by the Royal Australian and New Zealand College of Radiologists, the Radiation Therapy Advisory Panel of the Australian Institute of Radiography, and the Australasian College of Physical Scientists and Engineers in Medicine. Responding to the report, the government announced that it would launch an inquiry into the problems and act on that inquiry, frustrating the reports authors.
The governments new evidence inquiry will aim to develop a model to estimate the proportion of new cancer patients who should receive radiotherapy and brachytherapy at some time during their illness. The evidence-based panel, sponsored by the governments National Cancer Control Initiative, began its inquiry in March 2001, with a final report due in February 2003.
Robert Burton, M.D., professor and director of the Anti-Cancer Council of Victoria, praised many aspects of the ROTC report, but he acknowledged that "perhaps as much as 50% of radiation therapy use is a matter of opinion. Over the next 2 years, the new panel will examine randomized controlled trials, case control studies, and careful case series. ...The report has been a wake-up call to get the evidence, where good, poor, nonexistent, and to fund clinical research."
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The Benchmark
According to Kenny, "all the reports are consistent, but this one makes it more clear. We estimate that over 10,000 people in need of radiation therapy in Australia did not get it [in 2000]." Kenny said that if nothing is done, as the population ages in the next 5 to 10 years, this figure could easily double.
The 10,000-patient shortfall estimate hinges on a controversial assumption: a 50% to 55% national benchmark for patients with cancer getting radiation at some point in the course of their illness. About 38% of Australians with cancer are getting referred for radiation.
The 50% to 55% benchmark, which was suggested by the Australian Health Technology Advisory Committee in 1996 but questioned by the Australian government, approximates radiation use in many parts of the United States and other Western nations, said the reports authors and backers of the report. However, in these other nationsas in Australiathere is broad geographic variation in utilization, with uncertainty as to exactly what rate is best to ensure optimum outcomes.
Key Points
Besides pointing to underuse of radiation therapy, the report flagged long wait lists for radiation therapy, averaging 12 weeks or more in Australia and 20 weeks in New Zealand.
"Whenever a new facility opens, it is immediately swamped," said Lester Peters, M.D., chair of radiation oncology at Peter MacCallum Cancer Institute in East Melbourne, Victoria, Australia, who was not involved in the report. He attributed the lack of adequate facilities to the absence of a cohesive plan between federal and state government, with inadequacy of resources extending to staffing and training.
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Burton pointed out that Australia does not have a national cancer control program akin to what the World Health Organization recommends. He also noted that searches for qualified personnel in the United Kingdom and Canada will make it even more difficult to fill vacancies in Australia.
Separate Government Inquiry
A second, separate government inquiry also has infuriated some in the radiation oncology profession. It is eyeing the same issues that the profession did in its strategic report. According to Burton, "the terms of reference of the second inquiry" are to review and make recommendations concerning workforce, training, funding, patient access, and national standards for services and facility accreditation.
The second panel will also be charged with making recommendations on how the Commonwealth, the states, and private industry can collaborate and implement a nationwide strategic plan. The inquiry will begin next month and report its findings and recommendations to the federal government, probably in mid-to-late 2002.
A Very Clear Problem
Burton commended the reach of the professions strategic plan, acknowledging that it put forward "a lot of evidence, predictions, useful lifespans of equipment, and it pressed the training issue." He too maintained that there is "a very clear problem in manpower planning." One weakness is that the professions report "did not include health economists or research analysts, nor it spell out priorities or timelines."
He was not surprised that the new government inquiries have eclipsed the professions report. The government could not move on the professions report, observed Burton, because "they are inside the box."
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