Almost 150,000 new cases of cancer are estimated to have been diagnosed in Australia during 2020. A number of recent government initiatives aim to support and improve outcomes for Australians affected by cancer; but what specifically are these programs looking to achieve?
By the age of 85, one in two Australian men and women will have been diagnosed with cancer. It is also a leading cause of death; cancer accounted for almost 30% of all deaths in Australia last year. Although our cancer survival rates are among the best in the world, cancer still has significant impacts on individuals, families, communities and the health system across the country; and disparities in outcomes across population groups remain.
New data from Cancer Australia also shows that patients with lung cancer and bowel cancer are still more likely to be diagnosed in the later stages of the disease. While 92% of melanoma and 82% of prostate cancers are diagnosed at an early stage, only 18% of lung cancers and 46% of bowel cancers are detected early. While it is a concern, it also provides a substantial opportunity for improvement, as survival rates increase the earlier the patient is diagnosed.
A funding boost
In April 2021, the Australian government announced that it is investing $6.7 million to address the issue. The funding will be accompanied by a long term, national plan to improve cancer outcomes across the country, which will be delivered in partnership with Cancer Australia over a period of two years.
The funding commitment includes $4.7 million to help strengthen primary cancer care and genomic cancer clinical trials in Australia, and national leadership in Aboriginal and Torres Strait Islander cancer control as well as a further $2 million to investigate children’s brain cancer, breast cancer, melanoma and lymphoma and other important areas of cancer research.
A Ministerial Roundtable was held at Parliament House in Canberra on the 22 April as a first step in the development of a ten-year Australian Cancer Plan. Around 80 leading experts representing diverse groups including consumers, peak national clinical bodies, peak cancer and health organisations, industry and private sector, State and Territory Health Departments, the Australian Government and Cancer Australia took part in the discussions.
The Australian Cancer Plan
The new plan will set out the key national priorities and action areas over the next 10 years to improve outcomes for Australians, covering the whole process from prevention to early diagnosis, treatment and palliative care, while providing for the unique needs of specific cancer types and different populations.
The Australian Cancer Plan will focus on the future of patient centred cancer care, and will build on existing evidence and current progress and investment, while harnessing emerging evidence and technologies and innovations to improve outcomes for all Australians affected by cancer. A wide range of perspectives, including the Aboriginal and Torres Strait Islander perspective, will be taken into account.
Among the opportunities to improve cancer outcomes identified at the roundtable meeting was to provide joined-up national leadership, and to align with the National Preventive Health Strategy, reinforcing its messages. The government also wants to continue to promote value-based healthcare.
The Cancer Australia data referenced earlier showed that more bowel cancers among people aged over 50 are detected early, suggesting the national bowel screening program is effective. Increasing cancer screening rates, particularly in populations and areas where cancer screening participation is currently low or where disparities exist, is a key priority in the plan, as well as adopting new diagnostic tests for earlier detection of cancer.
The Preventive Health Strategy
Also in development is the National Preventive Health Strategy. Announced in June 2019 by the Minister for Health, the Hon Greg Hunt MP, the 10-year Australian government strategy for preventive health was due to have been launched, but development was paused for a time due to Covid-19. The latest consultation on the draft strategy has now closed.
Despite a substantial drop in tobacco consumption in the past two decades, lifestyle factors, such as tobacco use and poor diets – and related conditions such as obesity, high blood pressure and high blood glucose – are on the increase. Combined with obesity, inactivity is now rated almost as high as smoking in terms of health risk for Australians, and it is contributing to conditions such as diabetes, cardiovascular disease and various cancers.
The aims of the new strategy is to improve Australians’ health and wellbeing at all stages of life, through early intervention, targeting risk factors, addressing broader factors that influence health and better information. Building the cancer literacy of all Australians to improve understanding of personal cancer risk factors and empower behaviour change that reduces the risk of cancer was another topic.
Preventive health is a key pillar of Australia’s Long Term National Health Plan, which also covers mental health, primary care, hospitals, indigenous health and medical research. In addition, there are a number of specific action plans for Aboriginal and Torres Strait Islander people.
The Australian Brain Cancer Mission is a $133 million fund that supports research into brain cancer treatments. It aims to double the survival rate of Australians living with brain cancer over the next 10 years, to improve quality of life for people with brain cancer, give every patient a chance to join a clinical trial and boost Australian research and build research capacity. In the long term, the Mission aims to defeat brain cancer.
Signed by all Australian governments, the 2020–25 Addendum to the National Health Reform Agreement (NHRA) aims to improve health outcomes and ensuring the future sustainability of the health system. It is the key mechanism for the transparency, governance and financing of Australia’s public hospitals.
Through this agreement, the Australian Government contributes funds to the states and territories for public hospital services. In total, it will contribute about $133.6 billion between July 2020 and June 2025 for a series of long-term reforms, covering health literacy, prevention and wellbeing, payment of health services, local delivery and joint planning, enhanced health data and improved health technology decisions.
The reforms aim to reduce the burden of disease, including for cancer, and make it easier for people to manage their health and reduce pressure on hospitals. Governments will also work with the health sector to better understand and remove systemic barriers to improving health care.
What can we expect?
The Australian Cancer Plan and the Preventive Health Strategy are highly anticipated by a large number of stakeholders, but pressures related to Covid-19 has meant some initiatives have been delayed. The pandemic was a ‘watershed moment’, and it is very possible that long-term plans, timescales, budgets and forecast may need to be adjusted as a result of the pandemic and its impact on the healthcare system, although the overall aim should remain the same.
These strategies for improving health are good news, but as well as funding commitments and a strategy, a clear focus or direction will be `needed for plans to make a difference. Measurable targets also need to be set and performance needs to be tracked over time and communicated on. In their current form, these plans – except for the Australian Brain Cancer Mission – are all light on commitment to achieve any specific criteria or performance targets, so more tactical action plans with specific targets will need to be created. Providing the plans still stand in ten years’ time, how will we know if they worked?
A number of the strategies emphasise the importance on improving the collection, availability and reporting of data through a joined-up approach. This is an area that is improving rapidly, with the pandemic highlighting the need for up to date information at a national level, and in the coming years it should become easier to track the outcome of implementing plans and taking specific action.
Although, as a nation, Australia has already made huge amounts of progress with regards to cancer outcomes, the opportunity now to focus on early diagnosis and prevention could make a real difference. Once the Covid-19 situation has stabilised, it would be good to see concrete plans for tackling the various backlogs in terms of elective surgery and diagnostic procedures, including scans and endoscopy procedures aimed at diagnosing cancer, with clear targets and timeframes attached.