Aim:
To identify unmet cancer service needs and explore barriers to integrative oncology (IO) (where complementary medicine is integrated with conventional cancer services).
Method:
An Australian cross-sectional survey of 295 public and private healthcare organisations with cancer services, and focus group interviews and a survey of cancer survivors was conducted in 2016. One senior staff from each eligible organisation answered a questionnaire. Purposive sampling was used to recruit 154 cancer survivors from Anglo-European, Arabic, Vietnamese, Chinese backgrounds. Triangulation mixed method analysis was used to synthesise the quantitative results with the content and thematic analysis of qualitative results.
Results:
Despite 209 (76%) of the 275 participating organisations providing supportive care, this remained the most important unmet need across Australia. Seventy-one (26%) organisations provided IO. Four interrelated themes (finance, logistics, evidence, and culture) were identified as barriers to providing or accessing IO. The strongest convergence across data was financial barriers. For example, funding was the greatest barrier identified by 60% of non-IO providers.IO provision relied heavily upon patient payments, followed by philanthropy, and volunteer practitioners. Cancer survivors emphasised that IO was not a ‘luxury item’, rather it was an important adjuvant for side effects, comorbidity and rehabilitation. Views on solutions were more contentious. Some considered it was the patient’s responsibility. Others thought the public health sector should reduce socio-economic inequalities, or that higher rebates from private health insurers were required. Other important barriers were lack of IO service provision, difficulties in referral pathways, healthcare professional attitudes, and uncertainty around patient demand, services to provide and business models.
Conclusion:
The challenges identified with providing IO services are applicable to the provision of supportive care and survivorship services generally. We propose a patient-centred model illustrating the complex interrelationship between the thematic barriers, and healthcare professionals, cancer survivors and cancer services.