Regional Victorians can't afford to get cancer Oncologist and Cancer Council Victoria Clinical Network Chair Jeremy Millar outlines what role clinicians, the public health sector and government can play in reducing an inequity
Sometimes the stories arc heroic, and sometimes they are hcartbrcakingly sad. Bw they all have a common theme: the seemingly insurmountable problems facing people from regional and rural Victoria searching help and cure for their or their family's life-threatening illness. The stories are many and varied, and include: • A woman from the city who would drive 140km to Kilmorc to pick up her sick father to drive him to his nearest hospital, because he had no other way of getting there. • A farmer in his late 70s who was fit and working full-time on his farm when he w;is diagnosed with cancer. Even though he was well aware that radiotherapy was his besr treatment oprion he ultimately chose a worse option in his case, oral chemo therapy, because it allowed him stay on his farm. While it is true that Australian survival rates for many primary cancer types are among the hest in the world, the outcome for patients in regional and rural locations is substantially worse than patients from cities. A large part of this is caused by the 'tyranny of distance'.''*3 One of the dimensions in a high quality health aire system is equity, and in Victoria, cancer patients from the country would seem to have increased harriers ro accessing quality health aire in this respect. A recent article on the continuing trend of regional and remote disadvantage in cancer morbidity and mortality concluded that in the past two decades little progress had been made towards reducing the disparity.1 It was suggested that possible solutions include, "More support for regional and remote patients to travel to metropolitan centres (and more funding for associated accommodation)". State governments do have policies to assist country patients. The Victorian Patient Transport Assistance Scheme (VPTAS) offers Victorian patients a reimbursement of 20c/km if they use their own air to travel more than 100km one-way or 500km in a single week for treatment, and to claim $41 plus GST per night against the cost of commercial accommodation. The latest Victorian Department of Health and Human Services figures show the number of VPTAS claims has risen 13.5% from three years ago to 56,588 in 2014-15. This scheme is now helping thousands of patients, but is not fixing the problem of patients' out of pocket costs. Patients often tell Cancer Council Victorias information and support line (13 11 20) about how they only hair of the available assistance through word of mouth, and how it's often too late for them to access the VPTAS. While diere was a small increase to the reimbursement rates last year, overall they have not kept up with the inflation of travel costs for patients. Petrol costs are now S1.30 per litre and standard hotel rates in Melbourne are upwards of Si 00 per night. Patients who live 99km from treatment receive no help. The administration of the scheme is also time consuming and clunky, producing another obstacle for patients. Victoria does not compare well to other Australian states, which all have similar but generally more generous schemes. The only state or territory to offer less per night of accommtxlarion is South Australia at $40 and the only one to offer less per kilometre is New South Wales at 19 cents. In contrast, other states offer up to S66 per night for accommodation and up to 30 cents per kilometre for pettoL The State Government shows evidence of understanding and responding to the plight of country patients. List year, the former Coalition Government announced additional funding over four years for the scheme as part of the 2014 State Budget. Cancer Council Victoria has also welcomed the current Labor Government's commitment to review the scheme every two years, reduce processing time for claims and its plan to promote the scheme more heavily. But more work is needed both at an individual level and by building advocacy partnerships. Every member ol the AMA can assist in their everyday work by becoming informed of the VPTAS and telling their colleagues and patients. Cancer Council Victoria is one of the 30 community and health organisations that formed an alliance out of concern for die inequity country Victorians are experiencing when travelling for medical treatment. We will keep lobbying for a further increase to subsidies, improvement to eligibility criteria and for the subsidy amounts to be indexed to inflation. The inequalities facing regional and rurally based Victorians are caused by many factors and some are hard to fix, but help with transport and accommodation away from home is not beyond our control and resources. Let us hope that in the near future we will hear the stories that are heroic, and sometimes heart-warmingly happy. Together we can pitch-in to help country cancer patients.