Pioneers in telehealth: connecting outback communities with cancer care

Queensland is the second-biggest state in the sixth-largest country in the world. This sheer size becomes particularly apparent when you live in a rural or remote area and need to travel to access treatment. Medical oncologist and James Cook University (JCU) Professor, Dr Sabe Sabesan, knows the problems caused by distance and has created an innovative solution by harnessing emerging technologies.

Dr Sabesan has pioneered telehealth models in Queensland for cancer care and is the architect behind some of the state and national policies and frameworks. This decade-long research undertaking began from his work as a medical oncologist in the regional city of Townsville in the mid-2000s.

‘I was seeing firsthand the consequences of long-distance travel and relocation on rural patients,’ Dr Sabesan said. ‘It was disturbing patients’ family lives, their jobs and businesses, and adding a lot of financial pressure and stress. Especially with cancers, where survival may be limited, it can be distressing to spend a lot of time on the road for short consultations and treatments.

‘As a system and as doctors, we needed to do something about it. While we were searching for a solution, videoconferencing technologies came in front of us.’

Dr Sabesan and hospital colleagues began using videoconferencing to conduct medical consultations and monitor patients’ side effects from treatment. During a quality improvement exercise aimed at demonstrating the benefits of their innovative model, an unexpected opportunity arose. JCU’s Australian Institute of Tropical Health and Medicine (AITHM) launched its Cohort Doctoral Studies Program. One of the first of its kind in Australia, the Cohort program offered clinicians like Dr Sabesan the support, resources and networking opportunities to conduct postgraduate research.

‘The launch of the Cohort program was really good timing. It enabled us to examine our model of care while using research as a mechanism to develop the evidence base to demonstrate our impact,’ Dr Sabesan said.

Joining the inaugural Cohort in 2011, Dr Sabesan consolidated his work with a PhD project titled Enhancing rural and regional access to service delivery using teleoncology models and evaluating patient and staff experiences, safety and quality. From there, the project rapidly gained momentum and broke new ground.

‘Our North Queensland telechemo project was the world's first chemotherapy delivered via technology. No one had done anything like it,’ Dr Sabesan said.

‘So, on Thursday Island, a patient would have a doctor and a rural nurse with them, and they would connect with an oncologist and nurse in Cairns via video link. A pharmacist would check the doses and then the nurse would guide the rural nurse to deliver chemotherapy. The result is that patients have significantly reduced travel involved with treatment and fewer disruptions to their personal and working lives.’

As the research and published findings grew, the scope of the telehealth service delivery grew and evolved. The program was consolidated and expanded to provide telechemo to the broader northern Queensland region thanks to a grant from the Queensland Government’s Health Innovation Fund.

‘It’s through this model that places like Thursday Island, Atherton and Weipa, now all have chemotherapy closer to home,’ Dr Sabesan said.

Following the success of telechemo, Dr Sabesan and his team wrote the policy for the service, which is now published and being used Queensland wide to deliver chemotherapy remotely. But the expanding model didn’t stop there. It broadened Dr Sabesan’s horizons to what was possible and led him to look at clinical trials.

‘Through the implementation of teletrials, regional patients now have access to cutting-edge medications that they didn’t have before,’ Dr Sabesan said. ‘We then led the development of the national framework – Australasian Teletrial Model under the auspices of the Clinical Oncology Society of Australia.

‘These models have created a connected system where patients have access to a suite of services and rural health professionals are formally part of a system.’

These telehealth models have put North Queensland on the map as leaders in regional service delivery. In recent years, Dr Sabesan has brought together oncologists and JCU academics from across the region and formalised the primary objectives and vision of their program. Under the Australian Institute of Tropical Health and Medicine at JCU’s Townsville campus, the Tropical Centre for Telehealth Practice and Research was developed with a purpose-built telehealth facility.

‘From this project, you can see the legacy impact of clinician-led innovations on the broader health system and communities. There have been a lot of ups and downs, and a lot of personal sacrifice for us and our families. But we’ve always been focused on the goal and the outcome. It's all been worth it,’ Dr Sabesan said.