Concerns of those affected by breast cancer living in rural areas
Australian researchers have investigated the concerns of people with cancer living in rural areas of New South Wales, as well as their carers and health professionals.
The researchers recruited 36 people diagnosed with cancer, 14 carers and 32 health professionals. They participated in focus groups and interviews at four rural and regional hospitals (Bega, Dubbo, Tamworth and Albury) and three metropolitan treatment centres in Sydney including the Jean Colvin Hostel (an accommodation centre for patients travelling to Sydney for treatment).
Six main concerns were identified by the study participants:
- Access to health professionals was limited in rural areas because of inadequate numbers of health professionals working in regional centres.
- Treatment services in rural areas were limited, especially radiotherapy and palliative care.
- Travel for treatment was the greatest disadvantage for patients in rural areas, resulting in financial hardship, inconvenience and social isolation.
- Many patients and carers felt there was more specialised medical expertise available in city hospitals, and so travelled to the city for treatment at great personal expense.
- While patients felt that information and support targeted to them was sufficient, there was limited support available to carers
- Health professionals expressed concern about their reduced capacity to specialise (for example, they were required to treat all types of cancer rather than one particular type), the social and professional isolation of living in a rural area, and the distance from their patients.
The researchers conclude that the experiences of rural cancer patients, carers and health professionals could be improved by increasing the numbers of health professionals working in these areas, coordinating services around larger treatment centres in the area, improving reimbursement for treatment-related travel, and providing better support for carers.
For more information about this research, visit the PubMed website.
Rural women in America less likely to opt for lumpectomy
A large study conducted by the Mayo Clinic in the USA has found that women in rural areas are less likely to receive radiotherapy after a lumpectomy (breast conserving surgery), compared with women in larger cities.
The researchers studied the records of 341,540 women diagnosed with breast cancer who were treated between 1996 and 2008. 49,406 (14.5 per cent) of the women included in the study lived in a rural area. The researchers found that women living in rural areas were more likely to opt for a mastectomy than a lumpectomy. Those who had a lumpectomy were less likely to have radiotherapy than those in larger cities. Radiotherapy is often recommended after a lumpectomy to kill any cancer cells that may remain in the breast.
The researchers voiced concern over these findings, and stated that all women diagnosed with breast cancer should have access to the care that is recommended in clinical guidelines, regardless of where they live.
For more information on this study, visit the Mayo Clinic website.
Intensive chemotherapy appears safe in women living in rural areas
Queensland-based researchers have found that rural women diagnosed with breast cancer can safely receive intensive chemotherapy at the same doses as women living in urban areas.
Past research has shown that those diagnosed with cancer living in rural areas are often under-treated, partly because of fears that treatment-related side effects may not be effectively managed once they return to their rural homes.
The researchers of this particular study aimed to show that women with breast cancer could be safely treated with intensive chemotherapy and return to their rural homes.
The medical records of women who attended the Townsville Cancer Centre over a two-year period were studied. The records of women living in rural areas were compared to those living in Townsville.
The researchers found that there was no difference in serious side effects experienced between women who returned to their rural homes compared with those living in Townsville. Of the women in the study, two rural women were transferred to back to Townsville to manage their chemotherapy-related side effects, but all other rural women were able to have their side effects managed by a local doctor.
The researchers conclude that it appears safe to treat women with intensive chemotherapy and allow them to return to their rural homes, and most rural women who experience side effects can have them managed by a local doctor.
For more information about this study, visit the Wiley Online Library website.
Rural people with cancer share their experiences with psychosocial services
Australian researchers have identified some key issues about access to psychosocial services (services that help people cope with emotional and practical issues) by rural people with cancer. Seventeen South Australians living in rural areas participated in this study, including two women with breast cancer.
The researchers looked at the types of psychosocial services used by participants, and sought to better understand the particular issues faced by this population. Examples of some of the psychosocial services used included breast care nurses, counseling professionals such as psychologists, support groups, helplines and online forums.
Almost all participants (15/17) felt that the particular services they accessed were beneficial to them. They reported the services were helpful to reduce uncertainty, fear and loneliness.
- Strong support networks in rural communities were seen as beneficial by the participants. Community support, in addition to professional services, was valued by participants as helpful.
- Most participants reported a lack of information about the psychosocial services available to them.
Other barriers to accessing psychosocial services included a reluctance by many rural people to seek help at first, issues with stigma surrounding counseling, and feelings of being overwhelmed. Participants indicated that more relevant and targeted information should be made available to rural people with cancer. They also felt that psychosocial services should be offered as a standard part of cancer care.
To read the study abstract, visit the academic journal Supportive Care in Cancer.
People in rural areas seek help for cancer symptoms later
Australian researchers have looked at how people in rural Western Australia seek help from health professionals after experiencing symptoms of cancer.
Sixty-six people participated in the study, including 24 women with breast cancer. The study looked at the length of time between a person recognising a symptom, such as a lump in the breast, and seeking help from a health professional for the symptom.
Traits such as optimism, stoicism, embarrassment and fear were discussed by participants as core features of the rural Australian character. The researchers found that many participants with these traits waited longer before seeking help.
Two of the women with breast cancer waited a long time between finding their lump and seeking help. They were unsure about the lump they could feel in their breast, and had not discussed the lump with anyone else before seeking help from a health professional. In contrast, the women who sought help earlier had discussed their lump with someone close and had been re-examined by them.
You can read the study abstract on the Family Practice journal website.
Intensive Chemotherapy is safe for rural women
Researchers in Townsville have shown that intensive chemotherapy is safe for rural women with breast cancer.
Women in rural areas may need to travel significant distances for their chemotherapy. Chemotherapy side effects are often managed by their local, non-oncology doctors when they return home.
Women treated at the Townsville Cancer Centre have chemotherapy side effects managed by their local doctors. They receive phone and teleconference advice from treating specialists. Medical oncologists at the Townsville Cancer Centre are also able to review women urgently via video conference.
The researchers found that this model of treating rural women was just as safe as the treatment urban women receive. They demonstrated that various breast cancer chemotherapy regimens can be administered at the same dosage to patients living in rural communities, with no difference in safety or adverse side effects.
The study authors conclude that regular phone calls between specialists, women and local treating doctors, as well as teleconference review, help to monitor the side effects of women with breast cancer after they return home. They note that when doctors consider chemotherapy options for rural women, they should choose effective drugs that do not require long and costly travel. Concerns about adverse effects and side effects can be addressed by telephone and teleconference contact.
For more information, you can read the study abstract at the Internal Medicine Journal.
National Rural Women’s Conference - 18–20 February in Canberra
The inaugural National Rural Women’s Conference will be held in Canberra from 18–20 February 2013. The conference aims to bring together women who live in regional or rural Australia, to discuss key issues that affect them.
The conference is being hosted by the National Rural Women’s Coalition, and will include presentations across a range of topics which have been categorised into four conference streams: ‘Big Inspiration’, ‘Big Challenges’, ‘Big Business’, and ‘Big Networks’.
For more information about the conference, visit the National Rural Women’s Conference website.
Indigenous cancer patients satisfied with specialist video consultation service
Australian researchers have investigated the experiences of indigenous cancer patients located in regional and rural areas, who used the video consultation services provided at the Townsville Cancer Centre. The centre provides this service to allow patients to attend consultations with cancer specialists remotely.
The researchers aimed to assess the level of satisfaction of the video consultation service, from the point of view of indigenous cancer patients, as well as their family and health professionals.
They found high levels of satisfaction from indigenous patients, families and their health professionals, concluding that it is a valid method of facilitating communication between indigenous patients in regional and rural areas, and cancer specialists.
However, the researchers highlight that, for the service to be successful, all staff involved in the service should be appropriately trained and all patients must provide informed consent.
For more information about this study, visit the Australian Journal of Rural Health website.
QLD patient travel subsidy scheme doubled starting next year
The Queensland Government has recently announced that it is doubling the benefits available under the Patient Travel Subsidy Scheme (PTSS). The increase will take effect from January 1, 2013.
Patient Assisted Transport Schemes provide people in regional and rural areas of Australia with financial assistance towards the costs of travelling to specialist medical services for treatment.
The government has committed $106 million over four years to increase payments made under the scheme. Once the updated scheme takes effect, the accommodation subsidy will increase from $30 to $60 per night per person and the mileage subsidy from 15 cents to 30 cents per kilometre.
For more information on the change to this scheme, read the Queensland Government’s media release.
For information on travel schemes offered in other states and territories, read BCNA’s Patient Assisted Travel Schemes (PATS) fact sheet.
BCNA forum to support rural women
BCNA held an information forum in Alice Springs on 18 August, with 38 local women attending. Medical oncologist Dr Ru-Wen Teh, from Perth, spoke about the medical aspects of breast cancer; Raelene Boyle, BCNA Ambassador, shared her breast cancer story; and Associate Professor Jane Turner spoke on the emotional impact of breast cancer.
Raelene Boyle also participated in a radio interview with the Central Australian Aboriginal Media Association (CAAMA) where she spoke about her personal journey with breast cancer and depression.
To listen to Raelene’s radio interview, visit the CAAMA website.
To read an overview of BCNA’s recent Alice Springs information forum, visit the forums page on BCNA's website.
Telehealth benefits people being treated for cancer in rural Queensland
An Australian study has measured the satisfaction of patients located in Townsville Queensland, who participated in medical consultations that were delivered via videoconferencing (Telehealth).
The study involved 50 people being treated for cancer between 2007 and 2010 who had participated in a consultation with their cancer specialist via videoconferencing. During the consultation, a local health professional accompanied the patient.
The researchers found that 76% of patients did not feel that the accompanying local health professional was required during the consultation. The same proportion of patients felt that it was important for the specialist to provide a physical exam despite having a physical exam with the accompanying local health professional. Despite this, 96% of patients were satisfied overall with the Telehealth experience. In particular, participants were satisfied with the communication with their specialist during the consultation, and a reduction in travel time and costs.
To read the research abstract, visit the Wiley Online Library.
For more information on Telehealth, including information on the Medicare rebate available, visit BCNA’s website.
Rural women living in Canada less likely to opt for lumpectomy
A research paper recently published in the The Canadian Journal of Public Health has investigated whether breast cancer screening and treatment use by women is lower in rural areas, compared with women living in urban areas.
After reviewing the health records of 2,869 Canadian women, the researchers found that those living in rural areas were less likely to attend a screening mammogram compared with those in an urban area. Rural women were also less likely to choose a lumpectomy (sometimes called breast-conserving surgery) and more likely to choose a mastectomy, compared with those living in urban areas. The researchers hypothesised that this difference was because of the limited radiotherapy services in rural areas. However the researchers found no significant difference in the use of chemotherapy, hormone therapy, or overall survival between the two groups.
To read the research abstract, visit the PubMed website.
Rural women satisfied with surgeon communication
Research published in the Australian Journal of Rural Health has found that Australian women living in rural areas tend to be satisfied with their surgeon’s communication.
The study was based in eastern regional Victoria and involved 70 women, who were asked about their satisfaction with their surgeon’s ability to:
- tell the woman she had breast cancer
- provide information and involve the woman in decision-making, and
- prepare the woman for treatment.
The researchers found that more than 90% of women were highly satisfied with the interaction and communication with their surgeon. In particular, women felt their surgeon created a supportive environment for discussion, provided adequate information and referral, and women felt actively involved in the decision making process. The researchers concluded that practice could be improved for women who were alone during their consultation when they were diagnosed, as these women tended to make faster decisions about their treatment.
For more information on this research, visit the Australian Journal of Rural Health website.
New website provides practical information for people in rural South Australia
A new website, developed by The University of Adelaide, provides practical information to assist those affected by cancer and who live in rural South Australia. The site contains information specifically for people diagnosed with cancer, their family members, carers or supporters, and health professionals. Information includes:
- dealing with legal and financial issues
- managing the side effects of treatment
- coping with being away from home
- affordable accommodation
- going back to work
- how you can help your friends/family
- support services that may be helpful
While the website contains practical information for those living in rural South Australia (for example, where to find affordable accommodation for treatment) some of the information may be helpful to those living in other areas.
To find out more, visit the Country Cancer Support South Australia website.
Breast cancer follow-up care in rural Australia
There are significant limitations in follow-up care for rural women diagnosed with breast cancer, an Australian study has found. Researchers of this study interviewed 25 women living outside major Australian cities, and these women reported reduced quality and duration of follow-up appointments compared with their initial treatment; overlap in follow-up care; limited psychosocial and lifestyle support programs; and limited communication and coordination between health professionals.
The researchers called for greater communication and coordination of care between health professionals, and suggest that the new eHealth record system may help to facilitate this.
To read the abstract of this research, visit the PubMed website.
Does location affect unmet supportive care needs in Western Australia?
Research from Western Australia (WA) has examined the unmet supportive care needs for 786 cancer patients in rural and regional areas compared to those living in major cities. The supportive care needs survey highlighted that 52% of participants were from rural and remote areas. When participants were asked about their needs, there was no significant difference between the needs of those living in rural and regional areas versus those living in major cities. The survey participants stated that their largest concern was for their financial situation.
The researchers concluded that in WA, there is no difference between the unmet supportive care needs of those in different geographical locations. The study suggests that more research is needed to assess the unmet supportive care needs of carers and families, to help them support patients through their journey.
To read the abstract of this research, visit the Rural and Remote Health website.
Rural Flying Doctor Service recruiting Breast Care Nurse to be based in Broken Hill
The Rural Flying Doctor Service (RFDS) is in the process of recruiting a Breast Care Nurse to join their team. The position will be based in Broken Hill and will service far west New South Wales, south western Queensland and north eastern South Australia, to support those affected by breast cancer.
The position is in the process of being advertised, and the RFDS hope to fill it in the next two to three months. The new role will be a great service to women in these areas as the nearest breast care nurse is Mildura.
To read the article, visit the ABC News website.
Distress in rural cancer patients
Research presented at the American Society of Clinical Oncology Conference in Chicago, has examined the levels of psychosocial distress of cancer patients living in rural areas. The researchers asked 268 patients to complete a Distress Thermometer and Problems List at an outpatient oncology centre and found that 46% had a score of 5 or greater (with a score of 10 meaning extreme distress). When patients were asked if they were happy to participate in the various support services offered (individual counselling, support groups and wellness services such as yoga and massage) at the off-site wellness centre, only 10% agreed.
Reasons for not participating in the various support services offered included; lack of transportation, feeling that they didn’t need this help or that they were too far away and that they didn’t have enough time to undertake these activities.
The results highlight that psychosocial distress is higher in the rural population and that rural oncology clinics face greater challenges in patients accessing support services such as those listed.
To read the abstract, visit ASCO Annual 11 Meeting webpage.
Telehealth rebate for specialists
From July 1, women living in rural, regional and outer metropolitan areas will be able to undertake online video consultations with their health professionals and be able to claim this service through Medicare. For some women this may mean not having to always travel long distances for their appointments.
To read more about the new rebate, visit the Latest News webpage.
65 Million Regional Cancer Centre for Albury Wodonga
BCNA has welcomed the Federal Government’s announcement on 3 May to develop a regional cancer centre in Albury Wodonga.
This move is part of the Government’s $560 million commitment to develop new or upgraded cancer centres in regional and rural communities across Australia.
The Government has confirmed that the funds will be used to expand existing cancer treatment facilities at the Albury Campus of Albury Wodonga Health. This will include:
- the addition of new patient beds and spaces for oncology and haematology day patients
- upgraded radiotherapy equipment
- a new paediatric chemotherapy suite
- extended support services including a new wellness centre.
To read more about the funding please visit the Latest News page.
Barriers to telemedicine: the views of those using it
Researchers in Australia have examined the uptake and usefulness of telemedicine in rural and remote areas of the country. Results from a national study have found that the barriers to using such technology include: a lack of funding, infrastructure and skills; the extra time required to undertake a consultation; a lack of equipment; and the preference for traditional face-to-face consultations. Participants in the study highlighted that the lack of reliable internet access and difficulties in accessing a computer make equipment an issue for them.
The researchers highlighted that many rural doctors are confident in using teleconference facilities, telephone and fax machines. This combined with a preference for to-face communications can result in some doctors having a lack of interest in developing these skills. The researchers concluded that not using telemedicine at this point in time is quicker, easier and more cost effective.
To read the full text of this research, visit the International Electronic Journal of Rural and Remote Health Research, Education and Policy website.
The Federal Government is currently in the process of rolling out E-Health implementation sites which will include sites in Victoria, Queensland, Sydney, the Northern Territory and the Australian Capital Territory.
To find out more information about the different sites visit the website of The Hon Nicola Roxon MP, Minister for Health and Ageing.
Attitudes and barriers to randomised clinical trial participation for rural and remote patients
Research in North Queensland has examined the knowledge, willingness and barriers of participating in randomised clinical trials (RCT) experienced among cancer patients living in rural, remote and regional areas. Randomised clinical trials are research trials in which patients are randomly allocated to one of two treatments, either a new drug or treatment, or the current standard of care for the patient’s condition. Researchers then compare the outcomes of patients on the new treatment with the current treatment, to see if the new treatment is a better option.
For this research, the authors surveyed 178 patients in oncology outpatient clinics in Townsville and Mt Isa. The results found that the overall knowledge of clinical trials was poor in patients living in rural and remote areas when compared to those patients living in regional areas. The majority of those participating in the research said that they would participate in a RCT with the most common reasons being to further medical research, to help others and the hope that they could benefit from the trial or “have a better chance of being cured”. When examining decision factors for participating in a RCT the cost of travelling was very important to the majority of those participating in the research as well as the need to have family of friends accompany them.
The authors concluded that to increase the number of rural and remote patients participating in RCT’s, proposed trial budgets should include travel and accommodation costs for those rural patients.
To read the abstract of this research, please visit the Asia Pacific Journal of Clinical Oncology website.
11th National Rural Health Conference
BCNA staff members Amanda Winiata (Community Programs Manager) and Di Treble (Online Engagement Member) recently presented at the 11th National Rural Health Conference in Perth. Through their presentations they highlighted the work that BCNA has been doing with our rural, remote and regional members through the regional Forums and our online network.
The conference was a chance for BCNA to learn from the work that other organisations are doing in rural health and to hear from different speakers who have a passion for rural health. Speakers that presented included, BCNA Member and Western Australia Senator Judith Adams who spoke as a panel member regarding the need to see rural families as health consumers.
To find out more information about the conference and to see some of the presentations that were presented please visit the 11th National Rural Health Conference’s website.
To read the wide ranging recommendations developed by those who attended the conference, please visit the 11th National Rural Health Conference's website.
The effectiveness of expressive writing for rural women
Research from the United States has found that women involved in expressive writing at home, after radiotherapy, experienced improvements in their physical and psychological health after a period of three months. While the results found no difference in the effectiveness between women from rural or urban areas, they did highlight that women from a rural area were more likely to be involved in such writing. The researchers highlight that health professionals should consider the option of expressive writing at different time points in a woman's breast cancer journey and particularly for rural women.
More information is available on the US-based PubMed website.
Follow-up care of women with breast cancer living in regional Australia
Researchers in Australia have found that there is little access to follow-up care, psychosocial support and lifestyle programs for women with breast cancer living in regional areas of Australia. The researchers highlighted the need for better integration and communication between health professionals to reduce the burden of women having to travel to access different services.
Results from this small study of 25 women living outside metropolitan cities found that there was a decline between the care that they received during their treatment and that experienced at follow-up. Some women reported that there was considerable overlap in their care, which resulted in unnecessary time and travel costs for them. Women reported limited availability of medical providers in rural areas and a lack of psychosocial support and resources. The researchers noted that e-health initiatives could help to reduce the barriers that these women experienced.
To find out more about this research visit the Supportive Care in Cancer website.
BCNA online network
BCNA’s online network is a good place for women living in regional and rural areas to connect with other women in a similar situation. The network provides women with an opportunity to talk online with others who have been diagnosed with breast cancer.
Different treatment outcomes for Australian women treated in rural and regional centres
Researchers in Australia, examining the treatment of women diagnosed with breast cancer in a nine year period around Canberra have found that there are differences in those women who are diagnosed and treated in a rural area.
Researchers found that women treated in a rural setting were less likely to receive postoperative radiotherapy, or to undergo axillary lymph node surgery (ALND) or sentinel node biopsy (SNB) compared to those who were treated at metropolitan centres. Results from the research also found that surgery in rural areas was associated with increased recurrence rates and mortality. The authors highlighted that an approach to decrease these risks could include, developing initiatives that support rural surgeons to adopt new procedures such as SNB.
The researchers did find however, that all women, irrespective of whether they were treated in a rural or metropolitan setting were treated in accordance to evidence based guidelines.
To find out more information about the research visit The Breast Journal website.
To read about practical information and tips from other women living in a rural area with breast cancer see the website section Living with breast cancer: in rural areas.
Stay in touch
In the September Research Bulletin, we promoted the National Breast and Ovarian Cancer Centre’s Stay in Touch Program that allows women to stay in contact with their family via a computer link while receiving radiotherapy away from the home. To find out more about the program, including the locations at which it’s offered visit the Cancer Australia website.
Support needs for women travelling to the city for breast cancer appointments
Researchers in the United States have found that women travelling from rural, regional and remote areas for breast cancer appointments need to be supported and well prepared to get the most out of their appointments. Researchers spoke to women diagnosed with breast cancer, health professionals and community support staff and found that success factors for appointments included:
- being able to access high quality educational materials before your appointment
- having someone take notes for you during the consultation
- having a list of pre-prepared questions that you would like to ask during the appointment.
While the use of tape recording equipment was not raised by any of the women who were interviewed, when it was suggested to them, they agreed a tape recording of consultations would be useful.
For more information about the research visit the US-based PubMed website.
For more information and tips from other rural women diagnosed with breast cancer, see the rural areas section of this website.
Genetic counselling by videoconference – the counsellors view
Research from New South Wales involving genetic counsellors has found that videoconferencing is a useful method for delivering genetic counselling to people in rural and regional areas. Researchers found that genetic counsellors were satisfied with the process, that it reduced travel time and costs for patients and increased access to patients in these areas. Disadvantages of this method included, clinicians feeling that they were not easily able to develop a rapport with the women, non verbal cues were harder to detect, there was less time to explore the emotional aspects of the consultation, slow connection speeds and interruptions to the voice transmission.
It was agreed by all those participating however, that the advantages of this method outweighed the disadvantages.
For more information visit the Telemedicne and e-Health website.
Genetic counselling by videoconference – the patients perspective
Researchers from New South Wales interviewed women involved in the genetic counselling via videoconference project, and found that the majority were satisfied with their experience. The women felt there was a relationship with their off-site clinician and that the convenience of reduced travel and associated cost was an advantage. Disadvantages of this method included psychological needs not being met. The results highlight that this method is valued by women who are receiving hereditary breast and ovarian genetic counselling, but special care needs to be given to those with psychological needs and those who have been recently diagnosed.
For more information visit the Journal of Genetic Counselling website.
New program – Stay in touch with your family while receiving radiotherapy
The National Breast and Ovarian Cancer Centre (NBOCC) has launched the Stay in Touch program, which allows women to stay in contact with their family via computer link, while receiving radiotherapy away from home. Radiotherapy centres and families involved in the project are provided with laptops and webcams so they can talk each night via Skype (an online program that allows face to face discussions).
To find out more information about the program and which radiotherapy centres are involved contact Janelle Webb at Cancer Australia on 02 9357 9414 or email email@example.com
Limited access to breast care nurses for breast surgeons in regional and rural areas
Research undertaken by the National Breast Care Audit from the Royal Australasian College of Surgeons, has found that breast surgeons in rural areas have less access to breast care nurses (BCN) than surgeons in a metropolitan setting. Results from the survey found that 25% of surgeons in a rural setting didn’t have access to a BCN and that their patients had limited access to a BCN throughout their treatment.
It should be noted however that the research was undertaken in 2006 and that there have been some increases in the availability of BCN’s since that time.
For more information you can view the National Breast Cancer audit survey through The Breast website.
Access to emotional wellbeing resources in rural areas
Initial results from research in Kentucky, USA has found that cancer survivors living in rural areas have greater anxiety and distress levels and more emotional wellbeing concerns (referred to as mental health issues in the abstract) than those cancer survivors living in larger cities.
Results from the research further identified the need for more services to be developed and promoted in rural areas that allow cancer survivors to discuss issues regarding their emotional wellbeing and survivorship concerns.
For more information about this research visit the Psycho-Oncology website.
BCNA hosts forums in Northern Queensland
In mid June, BCNA headed to sunny Northern Queensland to host forums for women with breast cancer in Townsville and Rockhampton. Over 150 women attended each forum with the focus on ‘Living well beyond breast cancer’.
Both days were a great success with women, their friends and family members hearing from Raelene Boyle (breast cancer survivor), Dr Catherine Shannon and Associate Professor Nicole McCarthy (medical oncologists), Donna Nicholls (McGrath Foundation Breast Care Nurse at Gladstone), Kathy Jones (Breast Care Nurse from Townsville), and Dr Stephanie Dowrick (author and breast cancer survivor).
To find out more about the day and to see photos visit the BCNA forums page of our website
Rural forums for women around the country
BCNA hosted the second regional forum on Monday 29 March 2010 in Tamworth, New South Wales. The focus of the Tamworth forum and all our forums for the coming year is providing support to women in rural areas under BCNA’s ‘Supporting Women in Rural Areas Diagnosed with Breast Cancer Program’ funded by the Australian Government.
Over 200 women, friends and family members attended and was a great success. Guest speakers at the Forum included: Medical Oncologist Associate Professor Nicholas Wilcken, McGrath Breast Cancer Nurse Helen Goodall, breast cancer survivor Raylene Boyle and author and breast cancer survivor Dr Stephanie Dowrick.
A brief overview of the day is available to download from the BCNA website.
The next two Forums are being held in Northern Queensland in Rockhampton and Townsville in June with Forums travelling to Bunbury and Geraldton in Western Australia, during July.
Regional Cancer Centres around Australia
In the past two months the Australian Government has announced funding for Regional Cancer Centres across Australia. The funding will allow hospitals to purchase new equipment, establish accommodation facilities or to build a regional cancer centre.
More information regarding funding for your state or territory is detailed below:
Australian Capital Territory
- Funding has been announced for a Regional Cancer Centre that will cater for women living in the ACT and south east NSW.
New South Wales
- A new regional cancer centre in Nowra that will include new medical equipment, eight chemotherapy chairs and 10 accommodation places for women and their carers.
- Upgrades to radiotherapy services at the Illawarra Regional Cancer Centre and six chemotherapy beds.
Funding for a new facility at Gosford that will include the addition of three radiotherapy bunkers, medical equipment and an extra five chemotherapy chairs.
- Funding at Wyong Hospital to support a day oncology unit and a multidisciplinary clinic.
- New equipment for Lismore Base Hospital and a 20 room patient and accommodation facility to be built adjacent to the new North Coast Institute Regional Cancer Service.
- New equipment for Coffs Harbour Hospital to purchase an MRI machine.
- Funding for Port Macquarie Hospital for more equipment to be purchased.
- Tamworth and the New England Regional health area will receive funding for a new Regional Cancer Centre, medical equipment, and six chemotherapy chairs. An additional 14 accommodation places for women and their carers will be available at Tamworth Base Hospital.
- In January the Prime Minister opened the Darwin Radiation Oncology facility which will hold two linear accelerator bunkers, treatment areas for patients, consultation and examination rooms and support facilities.
- Funding for 16 chemotherapy chairs at Hervey Bay Hospital.
- Bundaberg Hospital will receive funding for 14 chemotherapy chairs.
- Funding at Rockhampton Hospital for new medical equipment and 16 chemotherapy chairs.
- Toowoomba and South West Queensland Integrated Regional Cancer Service will receive funding for 4 chemotherapy chairs, 12 inpatient and palliative care beds.
- St Andrew’s Cancer Care Centre will receive funding for medical equipment and 10 chemotherapy chairs.
- Townsville Hospital will receive funding for new equipment and 26 chemotherapy chairs.
- Mt Isa Hospital will receive funding for three chemotherapy chairs and a new building that will hold tele-oncology services and link women in regional, rural and isolated areas.
- Funding for a new regional cancer centre in Whyalla to include a day chemotherapy centre, in patient and palliative care facilities, a wellness centre, educational and research facilities and more accommodation for patients and staff.
- The development of a digital tele-health network that will create links between the Whyalla regional cancer centre, country hospitals and metropolitan cancer service partners. Additional radiotherapy facilities and equipment at the Lyell McEwin Hospital.
- The establishment of chemotherapy units in Mt Barker, Mt Gambier, Port Augusta, Victor Harbor, Clare, Murray Bridge, Gawler, Northern York Peninsula, Naracoorte and Port Lincholn.
- Funding for the Southern Areas Health Service in Hobart will provide new medical equipment, an Outpatient Cancer Care Centre, patient support services and resources for the tissue bank at Menzies Research Institute.
- Launceston General Hospital will receive funding for an expansion of the medical oncology unit, patient support and education research centre and palliative care upgrades.
- A new Cancer Care Centre will be established at the North West Regional Hospital in Burnie, which will provide 12 chemotherapy chairs and new medical equipment.
- Funding at Ballart Hospital for new medical equipment, 16 chemotherapy chairs and the development of a Wellness Centre.
- Expansion to the Gippsland Cancer Care Centre to include new equipment and chemotherapy chairs.
- Improvements to regional Cancer Centres in Bendigo, Traralgon, Albury and Wodonga.
- Improvements will include new equipment and up to 31 accommodation places for women and their carers in Ballarat and Bendigo.
- Nine accommodation places for women and their carers in Traralgon.
- Twenty accommodation places for women and their carers in Albury-Wodonga.
Mapping oncology services in regional and rural Australia
Australian researchers have found that only 21% of regional hospitals administering chemotherapy (RHAC) reported having a resident medical oncology service and only 7% had a radiation oncology unit. The research highlights the deficiencies in rural cancer services, with only 6% reporting they had a resident surgical oncologist. Further, only 24% of RHAC reported they had a palliative care unit and 39% had an oncology counselling service. The research team suggests that these deficiencies may contribute to poorer outcomes for people undergoing treatment for cancer in these areas Recommendations include a call for both short term and long term measures to improve access to oncology services in rural areas.
To view the full acticle, visit the Wiley InterScience website.
Home based exercise
A study conducted by James Cook University in Cairns has found that exercise DVD's could be a practical solution for people living in rural and remote areas to engage in rehabilitation therapy. The pilot study asked a group of nine patients to review DVD's that provided directions on therapeutic treatment. Overwhelmingly, all of the participants provided positive responses to the DVD's, and described the DVD's as useful and clear to use. Further research will be conducted on the compliance to the therapy DVD series. These interesting results suggest that this method of treatment may be suitable for other therapy treatments, such as for Lymphoedema or exercise programs for women in rural areas diagnosed with breast cancer.
Visit the James Cook University website for more information on the rural and remote patients home exercise study.
Beliefs of indigenous people about cancer
Indigenous people in Australia, New Zealand, Canada and the United States report a range of cultural factors that influence beliefs about, and experiences of, cancer. Commonly reported issues include fear of death, fatalism, payback and shame, and it is reported that these issues impact upon screening rates and participation in treatment. The researchers suggest that a holistic approach to cancer treatment in indigenous populations is a potential solution. It is also important for health professionals and service providers to understand that for indigenous people, concepts of individual, family and community are important and inseparable. This makes a big difference to indigenous people when considering seeking treatment and care. One recommendation is that more community-based research needs to be undertaken, to ensure that policy is guided by the needs of the community.
Visit the Wiley InterScience website for more information on this article.
Out of pocket expenses for rural Australians
A Queensland based research team have found that cost of cancer treatment varies greatly and is often very expensive for rural Australians. The researchers state that people in rural areas are travelling long distances and are burdened with the costs of travel in addition to treatment costs. The study involved 410 men and women in rural Queensland and showed over a period of 16 months after a cancer diagnosis, that the average cost for treatment was $4,311. For some consumers, costs were as much as $6231 across that time period. Personal costs, including travel and accommodation, were found to be significantly higher for those 100km away from the Townsville Hospital, and for those receiving radiotherapy. Recommendations include adequate financial support from governments and organisations to reduce the financial burden experience by rural consumers and ensure access to standard cancer treatment.
Visit the Cancer Council Australia website for further information on the research undertaken.
The vital role of cancer nurses in regional Australia
People treated for breast cancer in regional areas are found to have better experiences if a cancer care nurse is involved in their care. Researchers in Western Australia have found cancer nurses and cancer support workers helped individuals to navigate their cancer journey and ensure care is more streamlined to support the needs of the individual. Many previous studies have highlighted that people living in regional and rural Australia are often faced with insufficient resources and infrastructure to support their health care needs. The researchers suggest that these findings endorse the role of cancer specialists in provided better coordinated care in rural and regional Australia.
Visit the Nursing section of the LWW Journals website for more information.
Improving quality of life for women diagnosed with breast cancer in rural areas
Previous research has shown that it can be difficult to recruit rural consumers to long-term intervention programs. Researchers from the University of Alabama in the United States tested a Breast Cancer Education Intervention (BCEI) program for rural women after their diagnosis. The BCEI involved three face-to-face education and support sessions and two face-to-face and three telephone follow-up sessions, along with supplemental written and audiotape materials over a six month period. A sample of 53 rural women diagnosed with breast cancer were randomly placed either an intervention group that received the BCEI, or a control group that received 3 face-to-face sessions and 3 telephone sessions during the first 6 months of participation in the study, but not the BCEI intervention. After the six month period, all of the participants remained in the study. Overall, the group receiving the BCEI were found to show improvement in quality of life, and this was found to be significantly higher than participants in the control group.
Vist the Nursing section of the LWW Journals website for more information.
Peer Support Training for Rural Practitioners
The Rural Chemotherapy Mentoring Program (RCMP) conducted in rural South Australia has had a positive impact on the knowledge and development of rural health professionals. Mentoring from urban specialists provided information and support to rural practitioners around the protocols for administering chemotherapy and cancer care. The important transfer of experience was another successful aspect of the program. The RCMP works towards reducing health inequalities in regional areas, where there may be a higher incidence and poorer outcomes for people diagnosed with cancer.
Visit the Rural and Remote Health website to download a PDF version of the article.
Barriers to participation of Aboriginal people in cancer care
A study by Curtin University has found Aboriginal people feel that health care professionals need to consider a variety of cultural and political issues when providing treatment and care. Aboriginal people recommended a greater focus on cultural sensitivity, acknowledgement of family structure and community. It is also important for health professionals to consider possible fear by Aboriginal people of the health system, and the past and current political context for Aboriginal communities. One of the key recommendations from the study is the employment of more Aboriginal health workers in hospitals.
Visit the Medical Journal of Australia website for more information.
National Rural Health Conference
The National Rural Health Conference was held from 17-20 May 2009 in Cairns. Over 900 delegates from across Australia took part in the conference. Some highlights of the conference included Fran Baum (Flinders University) discussing the social determinants of health in rural communities, and a joint session by Mick Adams (National Aboriginal Community Controlled Health Organisation), Shannon Springer (Australian Indigenous Doctors Association) and Jenny May (National Rural Health Alliance) who discussed developments and commitments in Indigenous health. The Hon Nicola Roxon, Federal Minister for Health, gave the closing address at the conference.
Exercise preferences of rural women with breast cancer
In order to develop an exercise intervention program, researchers in the United States surveyed women with breast cancer about their exercise preferences. A survey was completed by 483 women. Rural women preferred home based exercise programs of moderate intensity, and walking. Women with higher levels of education showed a preference for sessions with exercise specialists. Results suggest that interventions need to take into account environment and social aspects of the lives of women with breast cancer. Programs with multiple options should be available, based on the preferences of different groups.
Visit the Wiley InterScience website for more information.
Service shortages in rural areas a concern
The New South Wales Cancer Council has reported that thousands of cancer patients have to go without treatment each year due to State and Federal Government disputes over costs. While Medicare covers the cost of some treatments, many patients are forced to pay many thousands of dollars for treatment in private clinics. Patients who cannot afford private clinics suffer lengthy waiting lists. As a result, many patients are not receiving radiotherapy within the recommended 21 days. While this report is specific to New South Wales, reduced access to services can be an issue in other rural areas around the country.
Workforce capacity in rural and remote areas
Australian Policy Online (APO) has highlighted a report by the Australian National Audit Office. The report has found that the Federal Department of Health and Ageing does not have a cohesive strategy to deal with shortages of health care professionals in rural and remote areas. The report concludes that there are a variety of causes for the workforce shortage, and to overcome them will require a multidisciplinary and multijurisdictional response. APO suggests that health care professionals need to move to rural and remote areas for a longer time, or on a more permanent basis.
The report on workforce capacity in rural and regional areas can be downloaded from the ANAO website.
Examining health disadvantages in rural populations
A study published in the Australian Journal of Rural Health has found that while living in a rural area may determine the level of access to health services; this does not always lead to health disadvantages. Researchers from Monash University and the University of Wollongong compared services available in rural and metropolitan areas in Australia, New Zealand, Canada, the USA, the UK and western European countries. Results suggest the lower number of services available does not lead directly to rural versus urban health disparities. Rather, health disadvantage is influenced by a range of complex factors. It may, however, compound the affect of factors such socio-economic disadvantage, poor service availability and high levels of personal risk. The researchers suggest that in order to improve rural health outcomes, health policies must take a holistic approach by targeting all factors that contribute to poor rural health outcomes.
Visit the Wiley InterScience for more information.