Integrative Oncology in Australia 2016: Mapping Service Provision and Exploring Unmet Needs

AIM: to identify specialised cancer service provision across Australia and providers’ and cancer survivors’ views on important unmet needs, barriers and facilitators. Given the high use of Complementary Medicine (CM) by cancer survivors, the focus was Integrative Oncology (IO) where CM is integrated with conventional cancer healthcare. METHOD: NICM conducted a cross-sectional national survey of 295 public and private healthcare organisations with cancer services. One senior staff member from each eligible organisation was invited to answer a paper/online questionnaire. Concurrently, purposive sampling of cancer survivors from Arabic, Vietnamese, Chinese and Anglo-European Australian backgrounds was used to recruit 33 participants for four focus group interviews and 121 respondents for an on-line survey. Triangulation mixed method analysis synthesised the results from the quantitative and qualitative data. RESULTS: The national survey response rate was 93% (275/295), from which 71 (25%) provided IO services for a median duration of six years. IO was provided in a variety of settings - inpatient (52%), outpatient (53%), dedicated centre (35%) and home/residential care visits (4%). The Northern Territory was the only state/territory with no IO services. Compared to non-IO providers, organisations were more likely to be owned by a not-for-profit company (46%) or were government owned (38%) (p<0.001). Provision was restricted at most sites to a limited range of non-biologically based services, most commonly massage (73%), wellbeing (71%), and movement modalities (39%). Institutional policies and information regarding CM products and practitioner services were generally underdeveloped and inconsistent for IO and non-IO providers alike. The most important unmet need identified by providers was supportive care services, including IO. Cancer survivors emphasised that IO was not a ‘luxury item’, rather it was an important adjuvant for treatment side effects, co-morbidities, rehabilitation and quality of life. Four inter-related themes emerged – finance, logistics, information, and culture – as the barriers and facilitators to IO. The strongest convergence across the data was financial barriers. IO provision relied heavily upon patient payments, followed by philanthropy, and volunteer practitioners. Funding was the greatest barrier identified by 60% of non-IO providers. Out-of-pocket costs were a significant personal barrier to accessing CM or more CM. Views on funding solutions were more contentious. Other important barriers were lack of IO service provision, difficulties in referral pathways, healthcare professional attitudes, insufficient evidence, and uncertainty around patient demand, which services to provide and sustainable business models. CONCLUSION: Australian organisations are increasingly providing IO services, signalling the need for clearer national guidance and polices. Discrepancies continue between what cancer survivors are doing or seeking, and the IO services they can access. Survivorship and wellness clinics are in urgent need of development. Coordinated strategic planning between all providers and insurers is required if the long-term needs of cancer survivors are to be adequately and equitably met. COLLABORATION: NICM and the Centre for Health Research, Western Sydney University partnered with South West Sydney Local Health District and the registered charity, Oncology Massage Limited.