Illawarra doctors fighting to help the cancer patients Medicare doesn't fund

Wollongong surgeon Bruce Ashford doesn't like to compare cancers, but after 15 years operating on hundreds of Illawarra residents with various types of head and neck cancer - he can't help but feel his
patients are hard done by.

"Breast cancer is terrible, but you can hide the scars of breast cancer, or bowel cancer, or any other type of cancer, but with head and neck
cancer the scars are on your face or they're on your throat," he said.
"Unlike every other type of cancer, you can't hide it because it's on your
face or it's in your mouth and it affects your ability to socialise, to talk,
to eat, to cough, to swallow, all those things."

Despite this visibility, Associate Professor Ashford said head and neck
cancer rarely receives the funding and attention it deserves.

That is why he and a team of other Wollongong clinicians - who are
celebrating 15 years of working together - are leading the push for
change.

Their big focus is that Medicare does not cover the costs for head and
neck cancer patients to receive prostheses which can improve their
quality of life.

"A prosthesis for an amputated leg is [covered], a breast prosthesis is
[covered], but not head and neck ones," Prof Ashford said.

An Illawarra contingent went to Canberra last week to lobby for facial
prosthetics to be included in a Medicare-style scheme, so patients don't face huge barriers after being cured of cancer.

"Head and neck surgery has the greatest cost to patients you could ever imagine," Prof Ashford said.

"But these people just push on, despite all the things we have to do to
them to cure them of their disease.

"I don't know many starving surgeons, but if you told me I could have a new ear for $15,000 and that would have to be replaced every three
years, I would still have trouble paying for that.

"So how are we expecting our patients from across the Illawarra to pay
for it?"

Gilmore MP Fiona Phillips raised this in parliament earlier this year
after she had a benign oral tumour removed, nothing that Medicare "of
course covers the removal of oral tumours in hospital".

"But if your tumour removal means cutting into your jaw, nose or face,
Medicare does not cover the reconstruction, so you might not be able to do simple and very necessary functions like eating and speaking," Ms Phillips said.

"If you have breast cancer or prostate cancer, Medicare does cover the
cost of a reconstruction, which is great, but, if you have head and neck
cancer, Medicare does not cover a reconstruction with technology
available. My grievance is: this needs to change."

Still fighting for better care

Until 2009, patients who needed complex microsurgical reconstruction
after head and neck cancer needed to travel to Sydney.

Prof Ashford, who led the push to establish a local surgical team, said
there was initially resistance but after a public campaign involving
some of the patients it would help, it went ahead.

The team now performs about 50 complex surgeries a year in
Wollongong's public and private hospitals.

"We've probably done about 700 major reconstructive cases, which
involve what we call a free flap - where you take a bit of someone's body from somewhere else and put it into a defect in the jaw or the face or the mouth or the skull," Prof Ashford said.

"It's a great credit to the hospital and to the community for supporting
us, and it's a reflection of the training that we all had.

"We have people come here from around the world to train now, and we speak internationally and train other surgeons internationally, so we're giving back in a way."

Anesthetist Tanya Selak has been part of the complex microvascular
reconstruction surgery team since the start and said she was proud so
many Illawarra residents had been able to be treated near home since
2009.

"Over the years, we've become much faster, much more efficient and
we've developed such a high-trust team," she said.

"I'm responsible for keeping patients safe whilst they're anesthetised,
and the operations themselves might last four, or six or 12 hours
depending on the complexity of the operation."

'A natural consequence of taking your job seriously'

As well as celebrating the 15-year milestone, the Illawarra's head and
neck surgery team took part in a 100km charity ride this month to raise
money and awareness about the illnesses they treat.

Run by Head and Neck Cancer Australia, and organised by Prof Ashford and Wollongong anesthetist Trevor Gardner, the Ride Beyond Five event raises funds for Head and Neck Cancer Australia.*

Prof Ashford said all this extracurricular work was "just a natural
consequence of taking your job seriously" for the Illawarra clinicians,
who hope to look back in 10 years and marvel at the advances in
treatment.

"For me, forever, this has been the least funded area of surgery and we
feel, because we're biased, like these patients are the ones that do it the hardest," he said.

"I think if you talk to the breast surgeons or the breast care people from
30 years ago, they would probably have said the same things, like 'we
can't get anyone to take this seriously, we can't get people to invest and recognise the loss that is related to the surgery we do'.

"I feel like that's the stage we're at now, and our job is to advocate for
our patients and their families and those people that are in their inner
circle by increasing access to care and reducing the impact
physiologically, financially, emotionally of that care."

Read the article in the Illawarra Mercury

Or download the PDF

Listen the ABC interview  A/Prof Bruce Ashford featured on Illawarra Breakfast to discuss the pressing need for federal funding. Skip to 2:18:00

The Missing Piece of the Puzzle: 2025 Pre-election Submission

Read more about Head and Neck Cancer Australia's for a 2025 pre-election submission:

Download The Missing Piece: 2025 Pre-Election Submission

Download the full Media Release 

Watch the Parliament Event: Head and Neck Cancer, a Critical Gap in Recovery

How you can help?

You can write to your local MP and ask them to support the funding proposal in the upcoming federal budget. See how to here.