The great divide

JRN317 Cancer Services

Cancer outcomes for patients in rural communities still remain “disproportionately high” when compared to their metropolitan equivalents.

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The locations of radiology services in New South Wales

The locations of radiology services in New South Wales

[CEO of the Rural Doctors Association of Australia Jenny Johnston said while the standards of services are just as good as those in the cities, problems face regional patients accessing health facilities.

“The statistics show that health outcomes for people living in rural and remote Australia, in particular, are significantly worse than they are for their urban counterparts,” she said.

“There are obviously issues around access to services and other factors that mean those health outcomes are poorer.”

As a result of the disparity between facilities in urban and rural areas, some patients have been turning down treatment because they cannot afford to travel to major metropolitan centres.

Andrew Gee, State Member for Orange, said before the investment of cancer facilities in Orange the only way people could receive lifesaving treatment was to travel to Sydney.

“It is unbelievable and indeed unacceptable that in this day and age we still have people in western New South Wales turning down cancer treatment because it is too hard to get to, they can’t leave family or work, or the whole exercise is just too expensive,” he said.

“There were people who were actually turning down the offer of treatment… which is really quite extraordinary and really just highlighted the great disparity between the level of cancer services offered in the country opposed to those in the city.”

Ms Johnston explained, as well as lack of services, the other factor affecting the health outcomes in western New South Wales, and other rural areas, is the “mal-distribution” of the medical practitioners.

“The problem is that that workforce is not distributed evenly so it is really heavily centred around metropolitan and major regional centres and therefore we don’t have enough appropriately skilled practitioners in rural and remote areas,” she said.

She says adequate numbers of professional medical practitioners and services go hand-in-hand when considering ways of improving health care in rural communities. She is worried the Government is not doing enough.

“Obviously it is very concerning for us and for our members. One of the aims of our association is to achieve a high standard of health care for Australian’s living in rural and remote areas and we see the role we can play in achieving this is to promote the recruitment and retention of a medical workforce, which is numerically adequate, which is appropriate skilled to deliver the services that are needed, which is located in the community where these services are needed.”


In March, the State Government committed $3.659 million for a second linear accelerator. The first ‘Linac’ has treated more than 680 patients since its commission in May 2011 – around 7 650 individual treatments.

New South Wales Minister for Health, Jillian Skinner, in a media statement said:  “The launch of this second Linac is an exciting development for the Central West Cancer Service, which will allow Orange Hospital’s radiation oncology team to provide lifesaving treatment to hundreds of additional patients from across the region.”

“The NSW Government is committed to providing health services closer to home for rural and regional patients and their families and the commissioning of this second Linac is a great example of this commitment becoming a reality,” she said.

The second Linac now allows an additional 350 people from across central and western New South Wales to receive treatment in Orange.

“[The] disparity in the level of cancer services available in the city compared to the country has been going on for far too long,” Mr Gee said.

He believes the development of radiotherapy services at the Central West Radiation Oncology centre, as part of the Orange Health Service, is “an important step in righting this wrong.”

“It is a multimillion dollar investment, but I think most people would say, people in the cities have this service and it is only fair and just that we in the country should have them as well,” Mr Gee said.

Orange acts as a midway point for individuals travelling from western New South Wales and Sydney.

Today, people as far away as Bourke, Cobar and Lightning Ridge travel to Orange for cancer treatment. By removing the need to go to Sydney, an extra four hours is cut from their trip.

24 per cent of the patients using the radiation service at Orange are locals, but everyone else come from the surrounding regions, including Bathurst, Lithgow, Oberon, Cowra, Parkes, Forbes, Mudgee and even Coonabarabran, Grenfell, Hillston and Young.

Care West Lodge was established to provide accommodation for those who had to travel large distances to access the service.

The Lodge has prevented hundreds from having to travel to Sydney for treatment, Jan Savage, regional co-ordinator for fundraising for Cancer Care Western New South Wales, said.

“With the Lodge where it is now in Orange, a lot of country people can go home to their families on weekends.”


The Lodge allows people the flexibility of being able to receive treatment, which can be up to seven weeks, while being able to keep their support networks close, Ms Savage said.

But it wouldn’t have been possible without the support of the Orange community.

“It is very community focused. The Orange community contributed very close to $2 million. We have also raised, it would be getting closer to $900 000 for the second stage for the Lodge and out of that, $750 000 has been raised by the community.”

However, the success of the radiation service at the hospital has meant a lot of strain has been put on the current facilities at the Lodge.

“We are almost one hundred per cent occupancy at the moment and we have been for some time. It is working in well with the existing service and the time frame; we work in with the hospital on the timing and service delivery,” Ms Savage said.

Funding the expansion has been difficult as there are no Government grants available for the Lodge. Nearly all the money needed has come from the Orange community – the very people who do not need to use the accommodation at the Lodge.

“We’ve actually had a part government grant for stage one and it was $1.3 million and the rest was raised by community fundraising. It would be very nice if we could actually get some support, but there is just no funding out there from the Government for a lot of projects.”

Ms Savage said the Lodge is currently working on building the additional eight rooms from the initial plans, constructing the original 22 rooms the Lodge envisaged. Funding issues kept the project to 14 twin-rooms for the first stage.

“We did not have the $5.4 million at that stage, we only had $4 million to actually build the Lodge, and the service infrastructure put it all into place and get it operational,” Ms Savage said.

“It is very tight at the moment and I think it is going to be very tight for some time.”

“The State [Government] has been quite generous because it fast tracked the facility; it fast tracked the implementation of the second linear accelerator. There are the ongoing operational costs associated with that service, it put that money in and yes, we do need more money. There is more money needed for cancer services, in general in the state, and everybody needs that money,” she said.

The community nature of the Lodge has helped country cancer patients go through treatment, but still with some support networks in place.

Ms Savage said community volunteers coming to the Lodge also help boost the spirits of the guests. She is amazed at how the community has embraced the Lodge.

“The people in Orange that have helped don’t want to see other people have to Sydney for treatment and that is why the community got in and pushed so hard, even though we’ll never use the facility,” she said.

The second stage of the Lodge will be completed in early January.]