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Using telehealth in remote oncology clinical trials

Photo: Rene Asmussen on Pexels
Clinical trials generate around $1 billion for the Australian medical industry from pharmaceutical investment, and yet the Australian rate of enrolment in clinical trials is lower than international recommendations and benchmarks; even lower for rural centres and trials including rare cancers.

The oncology industry considers the inclusion of clinical trials in a clinic’s regular practice to be important for research, innovation and funding for the research industry, with a clinic’s track record in trials being seen as an indicator of quality care.

A report into the recruitment and retention for Australian clinical trials revealed an unpredictable retention rate for trials, which makes it hard for trials to gain significant data, funding to be obtained for future trials, and innovations in treatments to be developed. Medicines Australia reported a decline in the number of pharmaceutical industry sponsored trials from 2007 to 2013.
While some barriers to recruitment and retention for clinical trials laid around leadership or clinical infrastructure to conduct the trials, Professor Sabe Sabesan, Director of Medical Oncology, Townsville Cancer Centre, decided to tackle the awareness issue, and lead the way combining his experience in rural health and telemedicine to bring oncology clinical trials to the GPs in Mount Isa from his base in Townsville.

Using Clinical Oncology Society of Australia (COSA), Royal Australasian College of Physicians (RACP) and Australian College of Rural and Remote Medicine (ACRRM) guidelines for delivering oncology care in rural and remote settings, Prof. Sabesan met with patients over video conferencing, who alongside their GP and primary care team, were administered chemotherapy dose intensity and toxicity under Prof. Sabesan’s instructions.

“There was no resistance from the clinicians in Mount Isa. The GPs were keen to get involved. They already care about their patients on a personal level, and they have the appetite to connect with the hospital network that they are so far removed from,” says Prof. Sabesan.

He believes the rural health workforce has what it takes to carry out clinical trials, and investing in their skills will only build and strengthen the health communities of allied health, nursing staff and medical officers.

“Telehealth is not an intervention.” Prof. Sabesan notes. “I want to avoid the confusion. Telehealth is a new method of care, connecting services and resources that are already in use, developed with a governance of standards and processes. We are not asking you to change anything about the way you care. “

He notes that the method is not restricted to patients who live in regional or remote areas. It could be applied to patients who live in the same city as the trial specialist, but are limited by transport or mobility issues. It is simply a way to access trials close to home.

“And you can do it within your department without too much fuss. Get your colleagues on board and you’re set to go. Just focus on your own thing and don’t stress about how it will work across the whole system. Making change within your own department is not that difficult.”

Prof. Sabesan was instrumental in developing the Australian Teletrial Model – Guide for implementation for COSA, which outlines the roles and responsibilities for carrying out clinical trials from the primary site to a satellite site using telehealth as a communication method.

A number of state health departments have joined the oncology teletrial network, which now spans the east coast of Australia. Prof Sabesan hopes the Australian Department of Health will take up the model to ensure it is built into a sustainable model of care across the country, and the progress made on telehealth in these communities is not lost.

The Cancer Nurses Society of Australia has endorsed the COSA clinical practice guidelines for teleoncology, which also include models of care for nursing and allied health services.

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Sharon Smith

Sharon Smith writes freelance articles as a medical, science and technology specialist. She is researching health journalism at Griffith University and lives mostly on Twitter @smsmithwriter (and would love to hear from you).