Breaking down barriers to palliative care
Care Plus Extend
More patients across Victoria with sarcoma, lung and colon cancer, including in regional areas, will have the opportunity to access high quality palliative care at an earlier stage under the VCCC Alliance’s Victorian government-funded Care Plus Extend program.
The program, funded in the Victorian Government’s May 2024 budget, will introduce a telehealth component as part of a study to examine the clinical and cost benefits of the Care Plus model of care. The Care Plus model involves practice change whereby palliative care is introduced at agreed times – trigger points – that are standardised for the different disease groups and which prompt a referral.
Care Plus Extend aims to increase the number of these cancer patients receiving timely palliative care by 25 per cent, which aligns with the new Victorian Cancer Plan goals.
Care Plus was previously implemented across four hospitals, delivering early palliative care to 231 patients with multiple myeloma, acute myeloid leukaemia and upper gastrointestinal cancers. While some data on this study is still pending, implementation outcomes reveal that Care Plus promotes practice change, is feasible and highly acceptable according to patients, families and clinicians.
The next step to make it available to more patients is to gain an understanding of the impact, costs and benefits in different settings and modes of delivery, including for regional patients and via telehealth. The extension of the program will be available to patients with sarcoma, lung and colon cancer at three metropolitan hospitals who care for patients across Victoria, along with regional cancer centres at Albury Wodonga Health and Latrobe Regional Health in Gippsland.
The three metropolitan hospitals are Peter MacCallum Cancer Centre, Royal Melbourne Hospital and St Vincent’s Hospital Melbourne.
Why sarcoma, lung and colon cancer?
“People affected by sarcoma often have to travel to metropolitan centres for treatment, due to the type and severity of their symptoms and are needs,” said study co-lead Professor Jennifer Philip from the University of Melbourne and St Vincent’s Hospital. “Lung cancer is a disease with poor prognosis and strong evidence of early palliative care, and colon cancer is a common cancer with multiple therapy options and highly variable existing palliative care referral patterns.”
The importance of timely palliative care
People living with cancer and their carers need information, as well as psychological and practical support. More than half of all cancer patients report pain, fatigue, and shortness of breath, and their families commonly report anxiety and inadequate assistance as they seek to provide support and practical care.
Meta-analyses demonstrate the benefits of introducing palliative care early, including improved symptom management, quality-of-life and care satisfaction, reduced rates of hospitalisation and emergency department presentations. Despite this evidence, and recommendations from professional bodies for ‘early’ referrals, access to palliative care often occurs very late in the illness.
“Our analyses of hospital data for cancer deaths in 2018 revealed that palliative care referral occurred a median 20 days before death. There remains a significant gap between evidence of best care and practice,” said study co-lead Professor Brian Le, Director of the Parkville Integrated Palliative Care Service, at Peter MacCallum Cancer Centre and Royal Melbourne Hospital.
Barriers to early palliative care referral include concerns about difficulty of referral, fear of destroying patient hope associated with perceptions of palliative care, and uncertainty over the ‘best time’ to refer. Current service delivery models are also an entrenched barrier with most palliative care being in-patient or community focused, yet early palliative care is best delivered in outpatient settings.
In Victoria, outpatient palliative care services are not widely available, particularly in regional areas, which offers opportunities for telehealth. “Innovative service models are required to address these barriers and bridge the evidence translation gap,” Professor Le said.
Professor Philip said people with a lived experience of cancer had co-designed the study. “This care package is designed with diverse consumer perspectives incorporated at the heart of the Care Plus Extend Model and our findings will be used to upskill and support the cancer workforce across Victoria, nationally and internationally to deliver improved outcomes for all.”
Care Plus is supported by the Victorian Government acting through the Department of Health.
