Outreach skin cancer clinics: improving access for those most at risk in rural and remote communities

  • Outreach provider, Dr Alan Jones from Skin Patrol consulting with a patient at a SCED clinic. Outreach provider, Dr Alan Jones from Skin Patrol conducting a full body dermoscopy.
    Outreach provider, Dr Alan Jones from Skin Patrol consulting with a patient at a SCED clinic. Outreach provider, Dr Alan Jones from Skin Patrol conducting a full body dermoscopy.
  • Nurse Lauren from Skin Patrol prepping a patient for surgery. Outreach provider, Dr Tim Bainbridge-Brown and Nurse Lauren from Skin Patrol undertaking surgery to remove a skin cancer.
    Nurse Lauren from Skin Patrol prepping a patient for surgery. Outreach provider, Dr Tim Bainbridge-Brown and Nurse Lauren from Skin Patrol undertaking surgery to remove a skin cancer.
By
Mary-Anne Quilter (Program Manager – Skin Cancer Early Detection) and Philippa Hawke (Evaluation Lead)
Queensland Primary Healthcare Network - CHECKUP
Issue
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It’s no surprise that Australia has the unenviable title of ‘Skin Cancer Capital of the World’. Our proximity to the equator, the time we spend in the outdoors (for work and play) and the fact that many Australians have fair skin are all contributing factors. Outdoor workers – many of whom live in our rural, regional and remote communities – are at higher risk than most of developing skin cancer, given their increased exposure to the sun’s harmful UV radiation.

GPs are our frontline defence in skin cancer early detection in Australia – with the Medical Journal of Australia reporting that 77% of melanomas were diagnosed by primary health care providers.  Many rural and remote communities, however, do not have a resident GP and are required to travel considerable distances to access a health provider – or are reliant on visiting locums, who don’t always have the capacity and/or experience to assess and treat suspected skin cancers.

Funded by the Queensland Government, CheckUP is currently delivering a Skin Cancer Early Detection (SCED) outreach service in five priority Hospital and Health Services’ regions across the State. GPs, with qualifications and/or experience in skin cancer medicine are contracted to visit communities with one or no doctors to deliver early detection services.

Outreach providers like RFDS set up temporary clinical rooms in town halls, local community health centres (where they exist) or the local neighbourhood or civic centre. These experienced and skilled GPs assess patients with a full body dermoscopy, sample suspicious lesions, administer cryotherapy and perform excisions and other surgical procedures. Their time with patients also presents an opportunity to promote self-skin checks and the five sun protection behaviours (slip, slop, slap, seek and slide) and encourage behavioural changes.

Initial patient feedback on the program from 100 patients has highlighted both the need for such a visiting service and a marked increase in awareness and knowledge of sun protection behaviours. Patients also indicated high levels of motivation to make positive behavioural changes in relation to their skin – committing to regular self-skin checks, increasing sun-safe behaviours and following up on referral appointments. In particular:

- 97% indicated an increased awareness/knowledge how to self-check skin

-99% indicated they are likely to commit to regular self-skin checks

- 99% indicated they are likely to increase sun-safe behaviours

- 93% indicated they are likely to attend a follow-up referral

-100% indicated they are likely to encourage family/friends to have regular skin checks

- 100% expressed they were satisfied or very satisfied with the service they received.

Notably, more than half reported they would need to travel more than two hours to access a similar service, while more than one in four noted they would not access a similar service elsewhere (due to time, distance and lack of transport).

A call for ongoing SCED services and increased visits was also common. The patient data to date also indicates a real need exists with close to 35% of patients who attended an early detection clinic in the first six months of this pilot program receiving treatment pre-cancer, and 50% of these patients having histologically proven cancers detected.

Skin cancer comes at a huge cost to government ($1.7 billion annually) and to individuals and their families who are diagnosed with melanoma. Increased funding for outreach services in rural and remote communities is needed to ensure early detection and treatment of skin cancers, particularly for our outdoor workers who are at higher risk of developing skin cancer in their lifetime.

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