Connecting the outback to cancer care

Dr Sabesan and hospital colleagues began using videoconferencing technology 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 says.

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,” Dr Sabesan said.

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 says.

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 says. “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.” Dr Sabe Sabesan

These telehealth models have put North Queensland on the map as leaders in regional service delivery. Dr Sabesan says if you ask someone in Melbourne or Sydney about teleoncology, they’ll tell you ‘talk to the guys in Townsville’. It was this growing reputation that led Dr Sabesan to consider the future of the program.

“There had been no systematic approach to the introduction of these technologies. All the improvements had been through individual efforts like ours. As leaders in the field of telehealth, we knew we needed to take a centre of excellence approach to continue innovating and maximising our impact,” Dr Sabesan said.

In 2014, 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. Dr Sabesan brought together oncologists and JCU Academics from across North Queensland and formalised the primary objectives and vision of their program.

“Through the centre of excellence approach, we were able to influence government policies and inform state and national roll-outs of our telehealth models. If I’d just done all this work myself then it would stop here in Townsville and go no further,” Dr Sabesan says.

As the AITHM Cohort Doctoral Studies Program celebrates its 10^th Anniversary in 2021, Dr Sabesan reflected on what being involved has meant for him and the progression of his work over the past 10 years. While the goal was never publication itself, the grounding in publishable research has proven the impact of the telehealth models and the benefit to society. As Dr Sabesan says, publications have been the ‘icing on the cake, rather than the cake itself’.

“For me, every publication is another lever to convince policymakers and colleagues of the benefits of these models. Without publication, your work lacks credibility. The Cohort Program gave us a methodology and a proven framework. The PhD process also strengthened different writing skills for me, which has led to writing policy for the state government.

“From this project, you can see the legacy impact of clinician-led innovations on the broader health system and the broader 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 says.