yuanyuan xie

No fair go for patients in rural areas

HOW do you place a value on a life? Is a prime minister's life worth more than that of a beggar?

Is a child's life more valuable than that of a pensioner? Are you considered more valuable if you have blue eyes instead of brown or even two arms instead of one?

Perhaps it depends on the type of car you drive or the clothes you wear? Maybe it's where you shop, or the friends you chose or how you style your hair?

Well, if you are sick in Australia - a country with state-of-the-art medical equipment and highly skilled practitioners - it seems the value put on your life depends much in part on where you live.

A study published by the Cancer Council of Queensland last week in conjunction with the Queensland University of Technology showing that the deaths of 640 bowel and breast cancer patients over a decade could have been avoided if there were no inequalities in survival across geographical areas in the state, serves once again to emphasise the lottery of location.

Every year doctors in this country tell more than 100,000 people that they have cancer - 36% of whom live in regional, rural or remote areas and for them the burden of the disease is disproportionally heavy.

Despite improvements in screening and treatments that have extended the five-year survival rates for many common cancers, rural cancer patients have not shared these benefits equally with their city counterparts.

Studies show that people with cancer in remote areas of Queensland are 37% more likely to die within five years of diagnosis and for cervical and prostate cancers that number climbs to 300%.

Government departments and cancer support organisations agree the reasons for the discrepancies are complex and difficult to attribute with absolute conviction but there is no denying that the major factors contributing to lower survival rates for people in rural areas include the restricted availability of diagnostic and treatment services as well as later diagnosis of the illness.

A report by the Clinical Oncological Society of Australia indicates that 38% of rural hospitals administering chemotherapy had neither a resident nor visiting medical oncology service and that only at 58% of rural hospitals were chemotherapy orders actually written by an oncologist at all.

In the main the problem is this - the lack of adequate medical services in rural and remote areas especially doctors and nurses who have specialities in specific treatments means that patients with chronic illnesses, in this case cancer, must often travel considerable distances to a major centre or city for treatment.

This travel is not only costly and disruptive to family life but means the patient who is already battling significant physical and emotional stress, often has to remain near the hospital for six-eight weeks, in a strange environment without the support structures that are so important in aiding recovery.

Financial concerns and time spent away from home may cause treatment delays or non-compliance for those living in remote areas with some patients opting out of recommended treatments entirely, potentially contributing to the poor survival outcomes of rural cancer sufferers.

It is not unusual, for example, for breast cancer suffers in remote regions to elect to have a mastectomy in preference to a lumpectomy or adjuvant therapy because they are concerned about out-of-pocket expenses and long periods away from home.

Over the last five years the state and federal governments have attempted to address the imbalances by encouraging newly-qualified doctors, especially those raised in the bush, to practice rural medicine and have opened the door wider for over-seas qualified health care practitioners.

Queensland Health has also, on the back of federal funding, opened private cancer treatment facilities in Toowoomba, Townsville, Mt Isa, Bundaberg, Hervey Bay and Rockhampton to ease the burden on the public hospitals in Brisbane and cut down the travel times of rural patients.

There is little doubt that the treatment facilities, in particular, will make a difference but one is cognisant of the fact it is only one part of what needs to be a concentrated attack with recent figures showing patients in the bush continue to be at a growing disadvantage.

The federal and state health departments were vague this week when asked what other measures were being put in place to finally eke out some semblance of equality.

There were general noises made about the complexity of the problem and much emphasis was placed on the screening program and the Patient Travel Subsidy Scheme as ways of first identifying people who required help and then facilitating their treatment.

But in reality the screening program and travel subsidy scheme bring with them an associated list of hurdles.

The former is linked with a GP's role in cancer care as more than 80% of patients with common cancers first present to their regular doctors with symptoms.

But the shortage of GPs practising in rural and remote towns has an impact not only on the education surrounding screening but also on the subsequent referrals, support and after care.

The Patient Travel Subsidy Scheme provided by the governments of each state and territories to help ease the burden of people who have to travel to access medical treatment is so wholly inadequate it could be laughable - if this was a laughing matter.

In Queensland patients get $30 per night to help with accommodation (a figure unchanged since the mid-80s) and 15c per kilometre travelled.

The lucky few are able to avail themselves of rooms offered by generous non-government organisations but long waiting lists for this type of housing often result in the majority having to find thousands of dollars for alternate accommodation at a very difficult time.

Research by some of our top universities, the Cancer Council, the Cancer Assistance Network and National Rural Health Alliance calls for a more structured uniform approach, more staff at regional cancer centres, a better use of rural networks, an investment in psychosocial support services for rural residents, an improvement in travel and accommodation subsidy programs and an effort to meet the needs of remote indigenous communities as a starting point to address the divide.

Fighting this disease is an expensive business and last year more than $4.2 billion in direct health system costs were dedicated to covering cancer treatment expenses.

Government departments talk about how costly it is to employ appropriately qualified staff, the millions it takes every year to fly oncologists in to remote areas, the challenge of implementing new technologies like telemedicine and the difficulty of balancing obvious needs with a tight budget.

More than 45,000 people died from cancer in Australia last year, about 4 in 10 deaths.

When you are seated behind a desk it is easy to remove yourself from the face of human misery so plain to see in radiation wards around the country.

For people battling the disease the war is about far more than numbers. It is about living to see birthdays and weddings, swimming lessons and recitals.

It is about being able to create memories with loved ones, teaching grandkids to bake, your daughter to drive.

It is about getting a fair chance at life.

That we lose so many of these lives, lives that could be saved, is a shameful tragedy.