Blood cancer was in the spotlight this month with a new report highlighting national inconsistencies in treatment access. Professor Chan Cheah at Blood Cancer Research WA is addressing that here.
Jan Hallam reports
The Leukaemia Foundation’s latest State of the Nation report highlighted the difficulty and the inequity of treating blood cancer in Australia, which often started right at the beginning of a patient’s journey.
“Getting an accurate blood cancer diagnosis and the best treatment can be challenging. Difficulties can arise depending on where a person lives and, in some cases, whether they can afford to pay for tests and treatments. It’s unfair that someone’s postcode or other personal circumstances could affect the quality of treatment they receive,” foundation CEO Chris Tanti said.
“The inconsistencies in Australia’s healthcare system directly impacts people with blood cancer and this is costing lives. We need continued focus on preparing and implementing national clinical standards to ensure Australians across the country are accurately diagnosed and have equitable access to skilled healthcare professionals who deliver best practice care.”
The report surveyed 4600 people with blood cancer, the results of which formed the cornerstone of its recommendations.
It found that, among some of the inconsistencies in accessing treatment, around 13% of people with blood cancer waited more than two months from their first appointment to obtain a referral to a specialist. A quarter of people with blood cancer were referred to one or more other specialists before being referred to the haematologist they needed. More than a third waited more than a month to see a haematologist.
When investigated, the report found that many life-saving blood cancer treatments and therapies used overseas weren’t routinely used or available in Australia yet.
And that’s what haematologist Professor Chan Cheah has worked assiduously here in WA since 2018 to address.
Professor Cheah is a model research clinician. He graduated in medicine from UWA in 2003, trained at Fremantle Hospital before heading to the Peter MacCallum Cancer Centre in Melbourne and the MD Anderson Cancer Center in Houston.
On his return to WA in 2015, he knew what treatments were being trialled over east and around the world, and what our blood cancer patients were missing out on.
Through his work at Sir Charles Gairdner Hospital, Hollywood Private Hospital and Linear Clinical Research, he was perfectly positioned to address the imbalance. In 2016, he started the charity, Blood Cancer Research WA, which increased exponentially WA blood cancer patients’ access to various clinical trials.
“There was a shortfall in clinical trial offering for haematology patients in WA. Compared with Melbourne and Houston, patients in WA were significantly disadvantaged and a lot of patients were at the point where they had run out of standard options,” he said.
“They were having to make a big decision – either relocate to the Eastern States for a clinical trial or receive palliative care. So, it was clear that we needed to bridge that gap by opening more trials to offer access to novel agents.
“We’ve been fortunate in the past 5-7 years, in particular, to have seen an explosion in highly effective treatments for patients with blood cancers, and the field is moving very quickly. However, the shortest possible time between a drug entering phase one trials and marketing (which almost always happens in the US first) is about 4-5 years. And in Australia, the delay until commercial availability is even longer.
“So, I identified pretty rapidly that the major barrier towards opening more studies and having more access to new drugs available for people was resourcing.”
However, there is some truth to the old adage, build it and they will come.
Patient demand wasn’t ever going to be an issue, but Professor Cheah did identify that having clinicians willing to step into the meticulous and time-consuming research realm was.
“There was a bottleneck for specialist time, especially in early phase trials where there’s a lot of safety protocols and assessments built in. It’s a huge amount of extra work for specialists to treat patients on study, and most people are already at maximum capacity just with their standard job,” he said.
“Not everyone has the desire to be a clinical trial investigator on top of everything else that they do. So, we established at Blood Cancer Research WA a paid pathway for fellows who are early in their career and have an interest in doing extra training as clinical researchers, and that has taken a lot of administrative burden away from specialists.
“Our charity supports the employment of five fellows and two nurse practitioners, through a combination of philanthropic money and partner institutions. The fellow’s role is to look after the patients, and they have had an enormous multiplier effect in terms of the ability to get people on study.
“It has allowed us to open complicated, labour-intensive studies and give doctors whose patients may have relapsed with whatever kind of lymphoma, an easy pathway to refer them for new treatment.”
This recruitment model has seen Blood Cancer Research WA increase its trial offerings over the past five years.
“Where four years ago, we had about seven or eight trials going and enrolling 30 to 40 patients a year, those figures have grown to about a rolling average of 30 to 35 studies a year enrolling more than 120 patients,” Professor Cheah said.
“A lot of those patients are still on study even two, three, four years later. The cumulative figure of close to 1000 patients that have been treated on study is because many of the drugs are so effective, the patients remain on study in remission. They are usually well and getting on with their lives. And that’s a great thing to see.”
In the few short years of its life, Blood Cancer Research WA has fulfilled a much-needed gap in offering patients not only treatment but hope, when hope was fading.
“I’ve received amazing support along the way. Philanthropists here have been incredibly generous and my colleagues around the State have been hugely collaborative by referring patients,” he said.
“Many of the successes we’ve had have largely been driven by referrals from people outside our own catchment. I think this speaks to the fact that my colleagues around the state know that we provide their patients a good service.
“Research organisations like ours depend on that collaboration – without that, we wouldn’t have been as successful because, like anything in life, the benefits come from scaling.”