Part III: A Decade of Upside Down Under

Julie McCrossin speaks at a Targeting Cancer event.

The indefatigable, irrepressible, indomitable Julie McCrossin is one of radiation oncology’s all-time best allies. By the early 2000s, she was a nationally famous Australian journalist/comedian/media personality/social activist, best known for her role on the popular TV comedy quiz show Good News Week. Her star was still rising in 2005, when she was tapped to co-host the popular Australian Broadcast Corporation Radio Sydney morning show. Alas, it was then that she was diagnosed with a head and neck cancer. That cancer didn’t know what it was up against.

Julie’s livelihood and identity were built on her wit and voice. Radiotherapy as primary treatment allowed her not only a chance for cure but also an excellent prospect for preserving her capacity to speak clearly. She has shown her gratitude in many ways, including years of unselfish service as an ambassador for the Targeting Cancer campaign.

This portrait of Targeting Cancer thus begins with an individual patient’s story, because Targeting Cancer was and always will be patient-centric.

Serendipity

Sandra Turner, PhD, MBBS

For those who don’t know, Targeting Cancer (https://www.targetingcancer.com.au/) is a large-scale educational/public-relations initiative sponsored by the Royal Australian and New Zealand College of Radiologists, aka RANZCR. As Sandra Turner, PhD, MBBS, summarized in an article from 2015 celebrating its first anniversary, “The Radiation Oncology: Targeting Cancer campaign aims to dispel myths and provide information for both patients and doctors on radiation therapy and where it can be effectively used.”¹

Dr. Turner recalls how it all started after one too many RANZCR committee meetings in which a buzz² of radiation oncologists were sitting around, lamenting the public’s lack of awareness and fellow doctors’ ignorance of the valuable role of radiotherapy in the treatment of so many cancers. “And so we just decided to stop complaining and do something about it.”

It was a departure from tradition for RANZCR to sponsor a program like Targeting Cancer, but the organization had a new CEO and a refreshed culture with appetite for novel challenges. The initial financial commitment was modest but adequate to move things forward, allowing for the hiring of an outside public relations consultant, for example. Dr. Turner, by virtue of her keen insight into the problem and potential solutions as well as her passion to tackle it, emerged as the obvious choice to lead the project. She was soon joined as de facto co-leader by Lucinda Morris, MBBS, a recent residency graduate who would be an invaluable liaison to the younger crowd. As Dr. Morris reflects, “In retrospect, there was a serendipitous nexus at that time of clinician groundswell and organizational motivation.”

Here I must set the record straight. True, RANZCR leadership were more open-minded in 2014 than previously. True, many radiation oncologists were frustrated with the status quo. But to say that those two conditions were sufficient is an infinite monkey theorem trap.^{3, 4} Sure, eventually something productive would have probably emerged, but the real serendipity was the accidental flame-accelerant teaming of Drs. Turner and Morris. Dr. Turner the sagacious mentor to Dr. Morris’ limitless vibrancy, both with charisma and people skills in superabundance. Attend one of their ESTRO leadership courses if you don’t believe me.

Target Practice

Lucinda Morris, MBBS

Targeting Cancer quickly gained momentum due to its infectious popularity. Dr. Morris recalls her own entrée: “If you work in radiation oncology, you understand how poorly appreciated and understood our profession is, and patients die or suffer because of that. So I caught the bug immediately. And lots of others did, radiation therapists, physicists, colleagues across all levels.”

One lesson in communication learned early was that doctorspeak was not going to work if the goal was to connect with patients. Radiation oncologists often quote clinical outcomes in jargon and statistical gobbledygook. “Symptomatic pneumonitis happens 9.3% of the time,” instead of “One in 10 patients will need medicine for shortness of breath.” As Dr. Turner put it, “We had to untrain ourselves and some of the other volunteers to not be scientifically pedantic, because that's what we're all trained to do normally.”

Dr. Morris adds that the lessons went beyond semantics. “We learned a lot about how to have humility… as clinicians in the workplace, we are used to people listening to what we say, but in the broader community and on social media and traditional media, the patient’s voice and story matter most.”

After a few years of honing the campaign’s content to resonate with the lay public target audience, RANZCR made a key strategic adjustment, narrowing the messaging emphasis from a broad “radiotherapy is great” to a more focused approach highlighting the value proposition of radiotherapy as the primary curative modality for prostate cancer patients in particular — a visionary decision, as we will see.

Fair Dinkum KPIs

Sadly, the Legend of Targeting Cancer does not include a boxing kangaroo,⁵ a crazed Tasmanian devil,⁶ or even an edgy platypus.⁷It would be charming to have a magical creature as fabular hero, but the reality is that Targeting Cancer’s success resulted from lots of hard work by lots of people. There was some fun along the way, but there was also a structured business plan full of legitimate key performance indicators (KPIs). Targeting Cancer was accountable to RANZCR for continued support, and progress had to be demonstrated.

A few KPIs: about 60 Targeting Cancer-initiated print, radio and traditional media stories have been shared across Australia and New Zealand focusing on positive radiotherapy-related patient stories, innovations and funding needs. Educational programs for general practitioners (GPs) have achieved measurable improvements in their understanding and willingness to refer patients to radiation oncologists.⁸ Workshops to expose medical students to radiation oncology have likewise paid dividends.⁹

Targeting Cancer's public service announcement has aired on Australian television since 2016, but the campaign extends worldwide through multiple channels. The videos have attracted over 60,000 views on YouTube, and the cumulative website traffic is approaching 1 million visits. In sum, across these and various other social media platforms, the global audience reach of the Targeting Cancer program is estimated to be over 150 million people. And then there is the biggest metric of all to date.

Periodically Australian Medicare, the country’s universal health service, offers a chance for public input into its coverage policies. In one of those windows of opportunity, the Targeting Cancer team mobilized in force to ensure patients’ access to radiotherapy for prostate cancer. The barrage included advocating to patient support groups, gathering signatures on petitions, producing videos to be seen in GPs’ office waiting rooms, and publishing policy statements about the benefits to patients. Ultimately, a few years ago, Targeting Cancer accomplished their goal. It is now written into the Australian Medicare regulations that urologists must refer patients with prostate cancer to a radiation oncologist or document a clear reason why such a referral is not needed, or else they risk fiscal repercussions.

Dr. Turner remembers that, as expected, they had encountered heavy opposition: “It attracted a lot of backlash, even though it was absolutely doing the right thing.” Bullseye.