Introduction
Rural access to specialist cancer care services can be improved through telechemotherapy models. In Northern Queensland, a novel telechemotherapy model (combining telemedicine, telenursing, and telepharmacy) was implemented by Cairns and Townsville Medical Oncology Departments, to provide chemotherapy services to rural and Indigenous communities.
Aim
To describe the feasibility, safety and sustainability of the telechemotherapy model in Northern Queensland.
Method
A descriptive analysis was performed using data collected retrospectively from the Townsville Cancer Center oncology information system (MOSAIQ) between 1st June 2014 and 1st June 2016. Demographics, episodes of care, primary tumour site, chemotherapy regime, dose reductions and delays, adverse effects, hospital admissions and mortality were described.
Results
During the study period, 62 patients (38 males and 24 females, 12.9% Indigenous) received 327 cycles of chemotherapy across 6 sites including Cooktown, Thursday Island, Weipa, Bowen, Hughenden and Ingham. Commonest cancers treated were Breast (35.5%) and Lung (17.7%). Treatment intent was adjuvant in 38.7% and palliative in 45.2%. Chemotherapy agents included low to medium-risk single and combination agents (excluding vesicants and Oxaliplatin) and monoclonal antibodies. Chemotherapy delays occurred in 54.8% on 68 occasions (4.6% neutropenia), with dose reductions required in 35.5% on 22 occasions (11.3% neutropenia). Grade 3-4 adverse effects occurred in 11.2% of patients, most commonly due to neutropenic sepsis (4.8%) and peripheral neuropathy (2.5%). Hospital admission was required in 13% of patients on 26 occasions, with no treatment-related mortality. Our results are similar to current literature.
Conclusion
Our telechemotherapy model in Northern Queensland is feasible and sustainable, facilitating the provision of chemotherapy services in rural and Indigenous communities with an acceptable safety profile. Adherence to strict governance, adequate resources, and collaboration between hospitals and clinicians, are important for a large scale implementation of this model. Studies will be required to further assess cost-effectiveness.