Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

Safe delivery of immunotherapy: A private cancer physician’s perspective (#79)

Christopher Steer 1
  1. Border Medical Oncology, Wodonga, VIC, Australia

As a medical oncologist in private practice in regional Australia service provision in general provides challenges and opportunities. The lack of a large well-resourced institution such as a public hospital with dedicated teams of clinicians is a clear disadvantage. Medical oncology practice requires the provision of 24hr care and it is important to be part of a team able to provide emergency care at any time. This is important for patients regardless of the type of therapy but is certainly more challenging in the private setting. Public hospitals will often provide access to high cost drugs (eg infliximab) that are more difficult to access in the private sector if they are not subsidised by the PBS or covered by private health insurance.

The advantages of working in private practice include autonomy, lack of bureaucracy, the opportunity to be nimble in decision-making and potentially provide patient care with fewer restrictions and delays. Care in private practice is also traditionally patient-centred with the continuity of the patient-doctor relationship being the cornerstone of the service provided.

Cancer care requires a team approach and whilst large public hospitals are built around these teams it is possible to work in a multidisciplinary team in private practice. Once oncology professionals accept the value of multidisciplinary care these teams form organically in the cancer care ecosystem regardless of the source of funding (ie the state or federal government).

Often the two services work together and this is particularly important in regional Australia, for example for the provision of emergency and intensive care services.

Once the teams are established, cancer care can evolve to manage patients regardless of the type of therapy. Management of the complications of immunotherapy just requires slightly different team members: dermatologists, gastroenterologists and endocrinologists are more important in this setting. Educating referring general practitioners of the complications of immunotherapy is also vital.

Whilst it is less common to find specialist nurses and nurse practitioners in the private setting these models are developing and will only serve to improve patient care in the years to come.