Statewide public radiotherapy services in Victoria: Getting out of service provider silos to improve equity of care and access to optimal treatment

ABSTRACT

Aim: The healthcare technological revolution has seen many treatment innovations become available to optimise cancer treatments. Radiotherapy has benefited from numerous such innovations however some of this unique equipment is expensive and often targeted towards specific anatomy or tumour types. To enable public radiotherapy services to offer these advanced treatments when very high capital cost was involved, the Victorian government-funded particular specialist radiotherapy machines, designating these as statewide services. This approach aimed to ensure Victorian patients that might benefit most could access these services without cost, while still receiving the rest of their care as close to home as possible. Methods: Government funded public MR linear accelerator (MR-linac) and Gamma Knife™ radiotherapy treatment machines. Both are significantly more expensive than a standard linac and only two of each existed in Australia - none in Victoria - prior to their acquisition. The Victorian 'Statewide radiotherapy services framework' was developed and published to underpin these new services and a website created covering indications information to support and facilitate appropriate referrals of suitable patients from within the state. Additionally, patient-reported outcomes were introduced as a routine part of these services. Results: The Victorian Gamma Knife™ service commenced treatments in 2021 and has already delivered over 135 courses of radiotherapy, 25% of these being for new indications. Treatments have been provided to patients from 85 different locations across the state. Although delayed due to the COVID-19 pandemic and limited worldwide installation expertise of this novel technology, the MR-linac service has just commenced clinical treatments. Conclusions: Statewide specialist radiotherapy services have been developed and implemented, providing fee free access to all Victorians irrespective of their place of residence. With more personalised cancer treatments becoming routine, a cost-effective way to have expensive equipment available to treat those who could most benefit has been established.