FormalPara Key Points

  • When the Alan Walker Cancer Care Centre opened in 2009, cancer mortality in the Northern Territory dropped by 15% within three years.

  • We provide a community-wide, culturally welcoming approach to cancer treatment, with long consultations prior to admission, specific support for carers, training for health workers, and a strong open-door policy.

  • Cancer treatment is rarely just about cancer. Most of our patients have other long-term illnesses that need to be managed alongside their cancer.

The Alan Walker Cancer Care Centre, at Royal Darwin Hospital, began operation in October 2009. Prior to 2009, most Northern Territory (NT) cancer patients traveled to Adelaide for treatment. In 2008, Royal Adelaide Hospital treated 160 cancer patients from the NT. Many patients missed out on appropriate treatment because they chose either radical surgery or complex chemotherapy. In many cases, this was because they didn’t want to travel.

In our first year of operation in Darwin, we treated 260 patients. Within three years, cancer mortality in the NT had dropped by 15%. I’m convinced that’s a testament to the power of local treatment.

Understanding Our Community

The NT’s population is around 245,000, with roughly one-third of the population identifying as Aboriginal and/or Torres Strait Islander. Many of these people live in rural and remote areas, with English as a second or subsequent language. Statistically, we’d expect one-third of our cancer patients to be of Aboriginal and/or Torres Strait Islander heritage. But that’s not how it works out—instead, the ratio is around 1 in 4.5. Over the years, I’ve gained a deeper understanding of the complex causes behind this disparity.

Different cancers

Aboriginal and Torres Strait Islander people are more likely to be diagnosed with “younger-age cancers”—including head and neck cancers, lung cancer, and stomach cancer. Non-Indigenous people are more likely to be diagnosed with “old-age cancers” like breast and prostate cancer, which tend to have a better survival rate. That’s one reason why we see more non-Indigenous people coming into the center for treatment and retreatment.

Traveling long distances

Aboriginal and Torres Strait Islander patients are more likely than non-Indigenous patients to travel and stay away from home for their treatment. They often travel long distances from remote communities and spend several months in Darwin having treatment. This increases the likelihood of them being reluctant to choose to have treatment.

Cancer may not be their highest priority

Many of our Aboriginal and Torres Strait Islander patients put the needs of their family and community ahead of their own need for treatment. People with caring responsibilities or family issues that need attention are likely to delay treatment for as long as possible. In addition, many people believe their symptoms are slow growing and not causing any major illness or debilitating conditions. They treat it like some of their other common health conditions, thinking it can be easily treated much later or it will heal itself. In these cases they will only seek medical help when the symptoms become unbearable.

A Community-Wide Approach to Treatment

From the day the Alan Walker Cancer Care Centre opened, we put a lot of effort into our community relationships. We wanted our patients to trust us and feel confident they’ll receive the best care possible in a welcoming and culturally safe environment.

Appointments prior to admission

We conduct a long consultation with our Aboriginal and Torres Strait Islander patients before they begin treatment, and we schedule appointments that are twice as long as the appointments for non-Indigenous patients. We have an Aboriginal Liaison Officer involved in all consultations, plus an interpreter if needed. We make sure there’s plenty of time to discuss the treatment and logistics. Our initial consultations are often conducted via teleconference and can involve anyone who needs to be consulted prior to the patient’s treatment—including the patient’s primary healthcare provider, family members, carers, and members of the community. Sometimes it’s the community Elders or relatives who make the final decision about whether the patient can travel to Darwin for treatment, and we need to respect that process.

Supporting carers

We’re careful to make sure that carers understand what the patient is likely to experience and how long the treatment will last. It’s very difficult for the patient if their carer leaves part-way through the treatment and the patient is left unsupported.

Training for health workers

We’ve created links between the Alan Walker Centre and health practitioners in the community and have conducted training for health practitioners right across the NT. Our goal is to make sure they feel comfortable with us and understand the optimal care pathways we use. We now have a network of care coordinators and health practitioners who know us and trust the way we work.

Open-door policy

We’ve implemented a strong open-door policy at the Alan Walker Centre. Any health practitioner is welcome to ring us directly and talk to our cancer care coordinators. We encourage them to call us if they have any suspicion that a patient may have cancer symptoms. Several of our staff have visited communities to understand more about primary care and disease management.

Cultural safety training

We’ve developed our own cultural safety training, particularly focused on cancer cultural awareness. We want our staff to understand why Aboriginal and Torres Strait Islander people experience different types of cancer and different barriers to cancer treatment. We also want our staff to consider how our patients understand and view cancer.

Welcoming environment

We’ve made the environment at the Alan Walker Centre as welcoming as possible. Even though we have a 27-room accommodation facility, most of our Aboriginal patients prefer to stay in the Aboriginal hostels. We offer a regular bus service to the hostels and make sure our patients and their carers can access whatever they need. We try to give them a home away from home because we want them to stay until their treatment is complete.

Managing comorbidities

Cancer treatment is rarely just about cancer. Around 90% of our patients have other long-term illnesses that need to be managed alongside their cancer. This is a huge issue for the patients who travel to us for treatment because they don’t have access to their usual health practitioners. We’ve developed strong relationships with local GPs and the Danila Dilba Health Service here in Darwin, and they do a lot of the heavy lifting for us in terms of chronic disease support.

Supporting the transition back home

When patients finish their treatment, we support their transition back home. We contact their primary health provider to discuss ongoing care and surveillance and make sure the transition home is as easy as possible.