ABSTRACT
Aims: To understand consumer and clinician experiences in utilizing telehealth in cancer care since the introduction of newMedicare Benefits Schedule (MBS) item numbers for telehealth in response to the COVID-19 pandemic. Method(s): A mixed-methods approach was used to collect qualitative and quantitative data on telehealth use during the pandemic: MBS services for cancer-related professional attendances were examined by delivery type, provider type and population group. Health service staff (n = 59) and consumers (n = 1162) from cancer services acrossAustralia were invited to complete online surveys and semi-structured interviews about the use of video and telephone telehealth, perceived effectiveness of video and telephone compared to in-person consultations, and the key barriers and enablers. A virtual roundtable was held with more than 40 key cancer control stakeholders regarding strategies to support the cancer community to offer and utilize best practice approaches to telehealth. Result(s): Telehealth was used across all stages of the cancer care pathway, and was most frequently used during the 'treatment' and 'care after initial treatment and recovery' stages. Although video consults were perceived to be more effective than telephone consults, telephone use was more frequent. Patients and their carers often felt less engagedwith their clinician during telephone consults and perceived that they were rarely given a choice between the consultation modes. Key enablers included medical leadership and administrative support, remuneration (MBS telehealth items), reduced risk of infection, reduction in travel time and costs and existing relationship between patient and clinician. Key barriers included inadequate infrastructure, lack of training, access issues (e.g., internet connectivity) and not being offered the choice of a video consultation. Conclusion(s): Telehealth is appropriate for the delivery of cancer care. A hybrid model of care (telehealth and in-person options) and the ability to give consumers choice is integral to supporting best practice telehealth in cancer care.
ABSTRACT
Introduction To investigate immediate and longer-term impacts of the COVID-19 pandemic on cancer care in Australia and to provide context for consideration of system-level and oncology workforce challenges, we examined provision of a range of cancer services during 2020. Methods As a marker of cancer control activity, we examined sentinel diagnostic and therapeutic procedures relating to 14 cancer types using claims data for the Medicare Benefits Schedule, a listing of medical services subsidised by the Australian Government. Results Impacts of COVID-19 on cancer-related services were observed early in the pandemic with observed number of quarterly services notably lower than expected for most cancer types nationally. Some recovery of services through to March 2021 followed with modest increases in quarterly services above that expected for some cancer types. However, sustained impacts overall for 2020 were observed for many services with 8% (163,595) fewer diagnostic and 9% (14,600) fewer therapeutic procedures observed nationally in 2020 than were expected from historical data.1 Conclusions Recovery of service numbers may indicate workload increases for an already over-burdened oncology workforce and may contribute to physical and psychological fatigue in service providers.2 Potential implications of sustained impact on services include later stage at diagnosis, increased treatment complexity and poorer outcomes. Understanding of ongoing impacts on care delivery can inform cancer control planning beyond the pandemic.
ABSTRACT
Background: Health professionals have reported significant reductions in cancer referrals during the COVID-19 pandemic. As national real-time cancer incidence data were not available, Cancer Australia designed an approach to analysing Medicare Benefits Schedule (MBS) data to provide evidence on the impact of the pandemic on cancerrelated services in Australia. Methods: Over 500 MBS items for diagnostic and treatment procedures for the five highest incidence cancers were identified and categorised into analysis groups based on cancer type and/or similarities in type of service. Data for January to December 2020 were examined at national and jurisdictional levels, and compared to 2019 to account for normal seasonal variation. Analysis of expanded data to March 2021 for additional cancer types, age, sex, remoteness and socioeconomic status, is being undertaken. Results: There were notable reductions in services across all diagnostic and surgical procedure groups. Initial reductions were observed between March and April for diagnostic procedures and between April and May for surgical procedures. Some services showed an initial recovery in May, and some showed partial or full recovery by June and further recovery by September. For some procedure groups, analyses showed sustained reductions over the 12 months to December 2020. Similar patterns of change were observed across all Australian states and territories, with some variation by jurisdiction. While the number of cases of COVID-19 were greater during Victoria's second wave of the pandemic (July-September), the impact on service numbers was less significant, likely owing to more refined policy approaches to managing health system and workforce capacity. Conclusion: Reductions in cancer-related services may impact patient outcomes, including recurrence and survival. Understanding Editorialmaterial and organization ©2021 John Wiley & Sons Australia. Copyright of individual abstracts remains with the authors. the nature and extent of this impact, including data disaggregated by population groups, will help to determine an approach moving forward to address any poorer cancer outcomes resulting from the pandemic.
ABSTRACT
Background: Australian oncologists reported dramatic decreases in cancer referrals during the pandemic. As real time data were difficult to acquire, Cancer Australia used surrogate measures to infer where reductions in medical services occurred. We analysed data available through the Medicare Benefits Schedule (MBS), a list of the medical services and professional attendances subsidised by the Australian Government, for the five highest incidence cancers: breast, colorectal, lung, prostate, and skin cancers. Methods: We identified over 500 MBS item codes for diagnostic and treatment procedures for malignancies and pre-cancerous conditions. Item codes were categorised into analysis groups based on cancer type and/or similarities in type of service. Data were examined at national and jurisdictional levels for 2020 to determine reductions during the initial COVID-19 period and to monitor subsequent recovery. Data were compared to 2019 to account for normal seasonal variation. Results: Australia's first wave of the pandemic ran from March to May, and a second wave in the state of Victoria alone ran from July to September 2020. We observed notable reductions across all diagnostic and surgical procedure groups examined, with initial reductions observed between March and April for diagnostic procedures, and a one-month delay for surgical procedures, between April and May. Some services showed an initial recovery in May, with many showing partial or full recovery by June. For some groups, analyses showed sustained reductions over the 12- month period. While COVID-19 case numbers were greater during the second wave, the impact on services was less pronounced, likely owing to more refined policy approaches to managing health system and workforce capacity. There was further recovery by September for some but not all services. Similar patterns of change were observed across all Australian states and territories, with some variation by jurisdiction. Conclusions: The pandemic has impacted the delivery of cancer care. Any potential delays in diagnoses and treatment due to these reductions in services may lead to more advanced cancer stage at diagnosis and poorer patient outcomes including recurrence and survival. Impact of COVID-19 on selected cancer services in Australia in 2020.