Patients living in remote Australia typically have poorer health outcomes relative to their metropolitan peers. Previous studies have demonstrated that outreach clinics resulted in a significant increase in referrals and access to specialist oncology services in Western NSW, and that RVAC is a safe means of delivering treatment to this population.
To determine whether the creation of a pilot RVAC unit in Coonabarabran increased the delivery of cancer therapies to patients living there.
Treatment data for patients in the Western NSW Local Health District (WNSWLHD) between October 2015 and September 2019 was interrogated. Patients were stratified into catchment areas based on their proximity to outreach clinics. Treatment incidence (TI), defined as the number of cancer treatments delivered per resident capita per year, was calculated in the catchments of Coonabarabran and Cobar, a similar sized town with the same socioeconomic index for area (SEIFA), before and after introduction of RVAC in Coonabarabran. Cobar residents continued to have all treatments in Dubbo.
A total of 1193 treatment encounters across these catchments were analysed. In the 24 months prior to RVAC, 27 distinct patients from Coonabarabran were treated (TI 0.0307), and 25 from Cobar (TI 0.322). Subsequently, 29 (TI 0.290) and 23 (TI 0.280) patients were treated respectively. The odds ratio for treatment for patients from Coonabarabran with the introduction of RVAC was 1.075 (95% confidence interval 0.632-1.810) and 0.920 across the same period in Cobar (95% confidence interval 0.521-1.623).
The introduction of RVAC has not significantly changed the use of cancer therapy. The reasons for this may include relative proximity of Coonabarabran to Dubbo, patient motivation, and the availability of community transport options. Further work will determine whether RVAC increases treatment delivery in towns more remote from major regional centres.