Outcomes versus Access: Who is Most Vulnerable? A ‘Wicked’ Issue for Cancer Surgery in Australia (#91)
Surgery is a critical component of the curative treatment for most cancers. Delays in the provision of surgery and having to travel long distances to receive surgery and its adjuvant treatments is stressful for patients and especially burdensome for older people and their families. In these circumstances patients often decline surgery. To compound this issue, recent Australian patterns of surgery and outcomes data supports international evidence that outcomes for complex cancer surgery are better when the surgery is performed in hospitals that do high volumes of these procedures. The volume-outcomes relationship has led to the centralisation of complex surgery, coinciding with changed referral patterns and reduced operative mortality rates. However, using centralisation to reduce variation in outcomes increases patient travel and restricts choice for more patients which can be a barrier to access to quality cancer care.
This symposium will comprise of 4 oral papers based on population data which describe lower cancer surgery rates in rural areas, especially in older patients; higher postoperative mortality in low volume hospitals where majority of rural patients receive treatment; higher rates of mastectomy and conversion from BCS to mastectomy in rural areas even among young women with small T1 size tumours; and geographic patient flows for cancer surgery. These papers highlight the challenges facing initiatives to improve cancer treatment access and outcomes in rural populations.
The papers will be followed by a panel discussion with inter-jurisdictional representation to explore the following key issues. What are acceptable rates of surgery in elderly and rural populations? Does patient choice make a difference? How much does distance impact on access to surgery?
This symposium supports a clinician led approach to the interpretation of the population data on surgery and outcomes that is currently being generated by health departments across Australia for policy development, cancer services planning and safety and quality initiatives.