Expert Review: An Overview of the COSA 42nd ASM by Kim Hobbs

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A theme of “Rare Cancers – Common Goals” for this year’s ASM, held in a “rare” (or at least less common) city, opened up the possibility for an innovative program – and that is exactly what was delivered.

The absence of a tumour specific theme meant that there was something for all delegates: clinicians from every discipline, as well as researchers and educators. Each day saw a dynamic variety of papers addressing the full spectrum of issues in cancer care service delivery. Sessions focused on truly rare cancers, along with rare presentations of more common cancers. Novel and emerging treatments were highlighted, alongside sessions on aspects of the supportive care needs of people living with cancer and their families.

For the broad range of clinicians whose primary role in cancer care is to provide treatments and services that support patients and caregivers throughout their cancer experience and on to survivorship, there were stimulating and thought-provoking concurrent sessions, all of which were well attended. The global picture of how best to manage the diverse needs of all people with cancer was well addressed in this meeting: from cutting edge, next generation therapies to innovative ways of providing psychological and emotional support.

The Big PictureThe session entitled “Equalising outcomes by reducing inequities” is reflective of this “big picture” approach. Startling and unacceptable differences in cancer outcomes were highlighted. Presentations in this session posed questions about reducing gaps in outcomes due to socio-economic disadvantage, as well as in Indigenous Australians. Cancer programs and services were urged to identify their under-served populations and to strategically address new approaches to reduce inequality: whether such differences in outcome be based on financial disadvantage, geographic isolation or cultural diversity.

The issue of health literacy is gaining currency with the realisation that around 60% of all Australians have poor health literacy. This has implications for treatment compliance and management of treatment-related side-effects.

An apple with the letter A carved out of the skin

The potential for poorer outcomes based on low health literacy alone will ensure that this issue becomes part of the conversation along with other inequities in cancer outcomes that are more commonly cited.

Innovations in service delivery models of cancer care were highlighted throughout the meeting. With a growing, ageing population and the major impact of alarming rates of obesity on the future incidence of some cancers, there is a challenge in all areas of oncology practice to “work smarter”.  At an overall population level, the number of new diagnoses is rising and survival rates are improving. Cancer care in the 21st century is frequently the management of chronic illness; often with a remitting/relapsing course that can extend over decades. This is “taxing” for the health economy, for the finite number of clinicians dealing with an ever increasing workload and for the patients and caregivers themselves who experience a long disease trajectory. The impact on health services and on family life are profound and long-lasting.

A refreshing angle on strategies to address optimal patient care was provided in the “Sharing the care” session. Better ways to involve primary care providers in the management of people with cancer has clear benefits for patients and their families as they transition back from the cancer treatment centre (often located a great distance from home) to the trusted relationship with their GP. With timely and relevant communication from the cancer centre, primary care physicians can confidently and safely provide follow up and monitoring of patients. GP’s are also well placed to identify psychosocial stressors and concerns of family caregivers and to make appropriate referrals for assistance within the local community.

An initiative that is strengthening service delivery in local communities is the utilisation of e-health technologies to improve shared care of regional and rural patients. This has obvious benefits in reducing health care system overload in the big centres and simultaneously offers benefits in terms of improved quality of life, less disruption and financial burden for patients and caregivers by reducing the occasions required to travel to the larger centre.

Perspective Support SignOn the point of local communities, it was acknowledged that frontline psycho-oncology professionals (psychiatrists, clinical psychologists and social workers), along with care coordinators, are primarily located in tertiary treatment centres. Access to community support to ensure continuity of care needs to incorporate consideration of a wide range of resources; particularly for patients and families in regional, rural and remote locations. Clinicians, patients and caregivers need to source services and resources from all agencies, including the growing number of web-based resources offering services such as individual and group therapies, education via webinars and opportunities for peer support. These services may include state cancer organisations, charitable groups providing support for particular patient cohorts and statutory authorities. It is incumbent upon clinicians based in major cancer centres to assist patients and carers to identify credible organisations that can provide practical, financial and psychological support when patients return to their local communities.

One of the more topical sessions on offer was “Pregnancy and cancer”. A sizeable audience gathered to hear four papers on issues pertinent to patients in whom the cancer diagnosis occurs during pregnancy. The range was broad: safety of cancer therapies during pregnancy, fertility preservation, outcomes for mothers and babies when treated for breast cancer during pregnancy and the emotive topic of how best to support couples who face a decision about terminating or continuing the pregnancy. The session concluded with moving first hand accounts from two women who had experienced the trauma of diagnosis and treatment during pregnancy. These women and their babies survived, but the impact on their psychological well-being was poignantly defined as they passionately recounted their stories.

The presence of two “consumers” in this session highlighted a feature of the development of the COSA ASM in recent years. The consumer mantra of “nothing about us without us” has been adopted by the meeting organisers. The Consumer Forum that precedes the ASM is now a regular feature, and once again was well attended in Hobart. In addition to the women who spoke in the pregnancy and cancer session, other consumers and representatives from consumer driven support organisations were given opportunities to have their say. In a first for COSA, a poster from Cancer Voices NSW celebrating ten years of the Consumer in Research Program was included in a best of the best poster session.

From both an organisational and participant perspective this was a successful meeting. Energy and enthusiasm was evident as all delegates reflected on ways to incorporate new ideas into their work and to meet the challenges of providing best practice care. This time the theme was rare cancers, but there was a clear message that the job of oncology practitioners and researchers is to strive towards the goal of making all cancers rare.

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About Author

Kim Hobbs

Kim Hobbs is a Clinical Specialist Social Worker for the Department of Social Work/Department of Gynaecological Cancer at Westmead Hospital. She holds a Masters degree in Social Work and has been working at Westmead Centre for Gynaecological Cancer in NSW since its inception in 1994. She is a COSA Council member representing OSWA.

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