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Pacific cancer patients struggle to find treatment

Cancer sufferers in the Pacific are finding it more difficult to get treatment. American Samoan health officials have stopped referring cancer patients overseas because of the high costs and there are few options for patients in other Pacific countries.

Presenter: Geraldine Coutts
Speaker: Professor Ian Olver, The Cancer Council of Australia's CEO

OLVER: There's a number of reasons, obviously geographic reasons are one, small population sizes and socio-economic status. Although one of the things that makes life difficult is that the well developed countries like Australia have very good cancer registries for actually counting cancers, and we don't know sometimes as much about cancer incidence in the Pacific.

COUTTS: So you would be advocating a registry then in Pacific Island nations?

OLVER: Well I think it's very important to have registries because you need to know the extent of the problem and you also need to know when you put a remedy in place to try and treat people, whether that's successful and whether your mortality rates are in line with the best around.

COUTTS: Professor Olver in articles, in a series of them that you've written on cancer and the disparity, you focussed on comparing Australia, Southeast Asia and the Western Pacific. What are some of the findings from that series of writings that distinguished the Pacific from the rest of the world that you studied?

OLVER: Well what I did because of Australia's registry, I first looked at the problems in Australia and then drew parallels with the Pacific. So in Australia we know that remoteness is an issue for example, and that the mortality rate in overall cancers tends to be higher if you live further from a big centre where there's a multi-disciplinary cancer centre. We also know that there are groups, like for example Aboriginal groups, that don't do as well with cancers and they tend to get the cancers that we regard as preventable, because they have a higher percentage of the risk factors, like drinking, being overweight, and perhaps not accepting treatment or screening, not participating as much in screening programs and then perhaps not getting the messages about prevention because there are cultural differences.

COUTTS: Well we did an item earlier in the week in American Samoa where there've had to be stop referring some of their patients to Hawaii and other places like that for radiation therapy and other treatments like that because of costs. You've also looked into the economic challenges of healthcare of cancer patients?

OLVER: Well that's right and some of the Pacific Islands have good links with countries like New Zealand for example, and there's a good pathway for referral of patients. But radiotherapy is very difficult, New Guinea's a good example of that. I mean they used to have some radiotherapy capability in Lae for example, but when the machine got too old it has never been replaced, and we're talking about 10 or 12 years. So you lose all your expertise, and you've got to send people out of the country for radiotherapy, and that means that people may get surgery for a cancer but not get the additional radiotherapy, so that people's treatment is compromised by just being able to have what's available locally.

COUTTS: Now PNG, that's right, the unit there was even second-hand, it was donated by India and was maintained for as long as it possibly could be but got beyond maintenance, and you're quite right they haven't got their unit back again, but nor has Fiji or a number of other countries got access to radiation therapy, and if the patients and the families can't afford to send them on these overseas expeditions, then they don't get anything. Why isn't aid going into this?

OLVER: Well I think that's a very good question, but what we've got to determine for each country is what the aid is best spent on. In most countries, and the figure changes a bit, to make a radiotherapy machine viable you probably need, well the figure varies between 150 and 250-thousand per machine, and ideally you should have two machines in case one breaks down, particularly if it's in a remote area. Now if you don't have that, then the question is, is it actually cheaper to use the aid to ship people off to the nearest higher density population to receive treatment? But once those figures have been done then that's precisely where the aid should be directed.

COUTTS: But how many hospitals can afford to take imports, because they've got stresses on their own equipment and staff and hospital beds, can they actually afford to accept patients from overseas now?

OLVER: Well I think that's a very good question, but we do know the figure, we know for example that about 53 per cent of people should have radiotherapy sometime during their treatment, and that's become a benchmark, and there are a lot of areas say in Australia that wouldn't reach that level. However, I think you've got to decide as a country that you have some responsibility to your neighbouring countries, and you've got to factor in a percentage of people to come in to use those facilities.

COUTTS: Well Hawaii we also heard in the interview earlier this week, its healthcare system is already over-burdened, and can't take on or afford to take on any more, so how can it continue to work that way if that's the centre that most of the northern Pacific are going to?

OLVER: Well it can't in terms of high-cost treatment, and that's where it's very important to look at the whole health system and say look, what's the screening and what are the prevention messages like? Because one of the great disparities is that in Australia the incidence of the death rate from cancer of the cervix for example is very low, and that's because over the last three decades or so we've had an excellent screening program, which is actually relatively simple, the pap smear program. Now that can be translated into other populations, but when we look at Southeast Asia and the Pacific we've got enormous rates of cancer of the cervix because there isn't a screening program. Now Australia has added the vaccine in, so we're going to drive our rates even lower, but you've got a lot of these countries that haven't even got a pap screening program. So I think there's got to be a balance not only with the high-cost treatments, but with the relatively low-cost screening and of course prevention messages about lifestyle.

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