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Labor's plan for cancer [media release] [and] Kim Beazley's plan to fight cancer.



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Kim Beazley - Labor's Plan For Cancer http://www.alp.org.au//media/1001/kbmscanc301001.html Wednesday, 31 October 2001

ALP News Statements

Labor's Plan For Cancer Kim Beazley - Leader of the Opposition

Media Statement - 30 October 2001

A Labor Government will commit $322 million over four years to a comprehensive strategy to improve the prevention, detection and treatment of cancer through a new national approach.

Labor will aim to reduce the number of people who develop cancer and increase the survival rate of those who have it.

This plan covers a wide range of initiatives to tackle a disease that is responsible for more than a quarter of all deaths each year in Australia.

One in three men and one in four women in Australia will develop cancer before the age of 75. Every year more than 70,000 Australians are told they have cancer. We all know someone who has been affected.

Fortunately, cancer is no longer a death sentence. Through the skills of our doctors and scientists and the technology in our public hospitals, there are now many treatments available.

Radiotherapy

I have today had the pleasure of visiting the Royal Prince Alfred Hospital in Sydney, inspecting cancer treatment facilities and talking to patients and staff.

One of the linear accelerators at the hospital was installed in 1964 and refurbished in 1991. The normal life of a linear accelerator is 10 years, yet the hospital has had to keep this one going for over 27 years.

Under Labor's package this machine will be replaced and an extra machine installed at the RPA one of four replacement machines and four new machines that are in the New South Wales package.

Nationally there will be $70 million spent from the Medicare Bonus on upgrading radiotherapy treatment and recruiting additional staff.

A recent report from Australia's top radiation oncologists concluded that more than 10,000 cancer patients a year are unable to get the most appropriate treatment for their illness. These experts estimated that this figure would double by the year 2005 under the current policies.

Note: The original three-year plan announced in May 2001, has been extended to four years and $70 million in new spending on radiotherapy added through the Medicare Bonus.

Kim Beazley's Plan to Fight Cancer

Authorised by Geoff Walsh, 19 National Circuit, Barton ACT 2600.

  Australian Labor Party   National ALP

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Kim Beazley's Plan to Fight Cancer http://www.alp.org.au//policy/health/fight_cancer.html Wednesday, 31 October 2001

Kim Beazley's Plan to Fight Cancer Acrobat PDF Version - 52 KB

Overview A New Sense of Urgency ❍ ●

Kim Beazley's Plan to Fight Cancer Expand and Update Radiotherapy ❍ Improved Access to Diagnostic Equipment ❍ National Coordination of the Cancer Effort ❍

Reducing Cancer Risk ❍ Detecting Cancer Earlier ❍ Stepping up Australia's Cancer Research Effort ❍ Translating Research into Practice ❍

Improving the Treatment of Cancer ❍ Continuing Care Outside Hospitals ❍

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Costing ●

Overview Labor will commit $322.5 million over four years to a comprehensive strategy to improve the prevention, detection and treatment of cancer through a new national approach. Our original three-year plan has been extended and $70 million in new spending on radiotherapy added through the Medicare Bonus.

We plan to reduce the number of people who develop cancer and increase the survival rate of those who have it.

Australia's recognised strengths in medical research will be better harnessed and new bridges will be built to link treatment services more closely to the best knowledge through Comprehensive Cancer Centres.

Australia already enjoys a good level of success in the treatment of cancer by

international comparisons because of the quality of our medical and scientific professionals. Around 59% of cancer patients are alive five years after diagnosis, with this figure being as high as 80% for breast and prostate cancer.

However, unlike the UK, USA and Canada, Australia has no National Cancer Plan and lacks a national direction and sense of purpose. It has made a relatively small investment in the key areas of research and translation of new techniques into clinical usage.

There are significant opportunities to improve the detection of cancers and better coordinate how we manage cancer patients in the health system. Labor's Plan to Fight Cancer unites all the nation's forces and seizes these opportunities so that cancer is controlled.

Australia needs to take full advantage of the rapid expansion of cancer knowledge to benefit cancer patients and ensure the latest research in Australia and overseas is available throughout the hospital system. These issues will be tackled as part of Labor's commitment to a Knowledge Nation.

A New Sense Of Urgency

Cancer is a disease that deeply touches all Australians. One in three Australian men and one in four women will develop cancer before the age of 75. Over a quarter of all deaths each year in Australia are due to cancer.

Every year over 70,000 Australians are told they have cancer. We all know someone who has been affected. For males the most common cancers affect the prostate, bowel, lung and skin. For women, the most common cancers affect the breast, bowel, skin and lung. Pre cancerous cervical abnormalities are common for women. Other significant cancers include melanoma, leukaemia and lymphoma. They all need to be tackled.

Labor has brought together the ideas of many experts working on research, treatment and prevention activities to produce an overall strategy to tackle cancer in Australia.

Kim Beazley's Plan to Fight Cancer Kim Beazley's Plan to Fight Cancer is about prevention, catching cancer early and providing the resources to treat cancer patients with the most up-to-date treatments. Labor's Plan unites all the forces against cancer and will:

1. Expand Radiotherapy, MRI and PET Scanning by:

Overcoming the serious shortage of radiotherapy linear accelerators and radiation therapists through support for the development and implementation of State-based Radiotherapy Plans;

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Sorting out the mess caused by the MRI scan scam and conduct an independent review to meet needs across the country; ●

Speeding up the introduction of Positron Emission Tomography (PET) scanning in public hospitals to provide access to better cancer diagnosis; and ●

Conducting a feasibility study into building a National Proton Accelerator, which may offer further benefits in the treatment of cancer and keep Australia at the cutting edge of scientific and medical research.

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2. Provide National Coordination of the Cancer Effort by:

Establishing a Prime Minister's Cancer Advisory Panel; and ● Establishing a National Cancer Alliance to directly link all the major players in cancer prevention, research, treatment and policy development. ●

3. Reduce the Risk of Cancer by:

Committing to reduce smoking within five years so that less than 15% of adults are regular smokers; ●

Funding the proposed national Sunsmart program to expand on the work being done by the States to cut skin cancer deaths; ●

Promoting other cancer awareness and risk reduction strategies; and ● Supporting new research into individual cancer risks and new screening technologies. ●

4. Detect Cancer Earlier by:

Undertaking a large melanoma Screening Trial in Queensland; ● Establishing a targeted cervical cancer screening program to reach women who do not currently have regular pap smears; ●

Trialing bowel cancer screening using a new "in the home" test; ● Increasing breast cancer screening rates; and ● Evaluating new screening tests for prostate, ovarian, lung and other cancers and investigating the adoption of new technologies. ●

5. Step up Australia's Cancer Research Efforts by:

Making cancer a strategic priority in NH&MRC grants procedures; ● Supporting basic science research and infrastructure that underpins advanced cancer research; and ●

Promoting national and international collaboration. ●

6. Translate Research into Practice by:

Establishing Comprehensive Cancer Centres that become hubs of high level research and clinical expertise each supporting a network of teaching and regional hospitals providing oncology treatment so that high quality cancer treatment is available throughout the public hospital system to all cancer patients;

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Providing funding for national clinical trials so that the latest research and procedures are tested quickly so that their application to patients is not needlessly delayed; and

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Speeding up the adoption of new cancer treatments developed in Australia and overseas. ●

7. Improve the Treatment and Coordination of Cancer Care by:

Implementing best practice Cancer Treatment Guidelines so that patients receive quality, up-to-date care; and ●

Funding the development of clinical information systems to ensure that doctors have access to the best information. ●

8. Continue Care out of Hospital by:

Reforming the hospital pharmaceutical system to enable patients to access specialist cancer drugs as outpatients at home; ●

Ensuring palliative care gets a more significant share of total hospital funding; and ●

Providing better counselling and support services to cancer patients and carers with the further development of cancer care nurses and GP liaisons. ●

Expand And Up-Date Radiotherapy Equipment

There is a substantial deficiency in Australia in radiotherapy services. Many machines are due for replacement and the number and distribution of machines is inadequate for the needs of a growing population.

In 1996 the Australian Health Technology Committee recommended increasing the number of machines so that 50% of cancer patients could be treated (compared to the current average around 40%). No national action has been taken to meet this shortfall. Instead a new study has been set up to review the standard - but this will not even report for another 18 months.

There is a shortage of Linear Accelerators used to provide radiation therapy to people with cancer. The international benchmark is that at least 50% of cancer patients should get access to radiotherapy. In Australia less than 38% of cancer patients are getting this treatment.

A recent report from Australia's top radiation oncologists concluded that over 10,000 cancer patients a year are unable to get the most appropriate treatment for their illness. These experts estimated that this figure would double by the year 2005 under the current policies.

There is a need for a major re-equipment program for public hospitals. Linear Accelerators cost around $2.5 million each and many are past their useful life. Of the machines over 10 years old, all 14 are located in public hospitals.

Labor's new funding will enable the States and Territories to implement plans to put new Linear Accelerators in un-serviced areas and to replace ageing equipment in the major cancer treatment centres. It will also allow the States and Territories to increase their staffing to make better use of the upgraded facilities.

Labor will work with each of the States and Territories to develop and implement a radiotherapy plan that makes adequate provision to replace outdated machines and to locate new machines so that radiotherapy services are more accessible. Additional funding will be provided through the Medicare Alliance to assist the States. Particular attention will be paid to providing access for patients to radiotherapy services to overcome the inequities for rural and outer metropolitan cancer patients.

Addressing Future Staffing Needs

This neglect has also created shortages in specialist staff, as radiotherapists, oncologists and medical physicists look elsewhere for opportunities to use their professional skills. Many have chosen to go to Canada, which is actively building up its cancer treatment resources and pursuing overseas specialists. Labor will reverse this trend and provide the professional support and training positions needed to build our own knowledge and skill base.

Action will be taken to address looming shortages for medical specialists in areas such as medical oncology, surgical oncology, palliative care and cancer genetics. Other professional workforce shortages will be addressed through additional training positions for radiotherapists, radiographers, radiation oncologists and medical physicists and retention strategies will be implemented.

The Prime Minister's Cancer Advisory Panel will be asked to urgently review future workforce projections to make recommendations for training for all key cancer specialties to ensure we do not fall behind again.

Improved Access To Diagnostic Equipment

Magenetic Resonance Imaging

The Government has bungled the introduction of MRI scanning and has delayed the introduction of Positron Emission Tomography (PET scanning) by two years of procrastination.

The Howard Government has been heavily biased towards private health. Medicare rebates for new technology have been allocated to private specialists whilst public hospitals have been denied access to funds to buy important equipment.

The most notorious example has been the MRI scan scam - the largest medical fraud in Australia's history. That scam resulted in an oversupply of Magnetic Resonance Imaging (MRI) scanners in private hands. Many major public hospitals still do not have an MRI scanner.

Labor will sort out the MRI mess in the interests of patients with an independent examination of needs across the country. There is a growing gap between the technology available to private specialists and that available in public hospitals because of the policies pursued under John Howard. This equipment backlog is inexcusable and Labor will reverse the trend.

PET Scanners

Labor will also speed up the implementation of PET scanning in teaching hospitals so that this important technology can be more widely accessed and evaluated. There is funding for seven PET scanners in the forward estimates and Labor will sort out the delays and approve contracts for public hospitals to use this technology in the diagnosis of cancer.

The Howard Government has belatedly made an election promise to issue six of the overdue licences but this will leave WA without this important equipment and there is no guarantee they will not issue the licences to private providers as occurred in the recent round of MRI licences.

Labor will conduct a feasibility study into building a National Proton Accelerator to gain access to this emerging cancer treatment technology, which may offer benefits in the treatment of cancer and keep Australia at the cutting edge of medical research.

National Coordination Of The Cancer Effort

Labor will bring a new sense of purpose and reform to the way in which cancer programs are organised and funded. Under the Medicare Alliance the States and Territories and the Commonwealth will be able to combine their efforts and work together.

An Australian Cancer Plan

Specifically, we will develop an Australian Cancer Plan within the first 12 months with targets, performance measures and spending commitments.

There is currently no agency in the Australian health system responsible for monitoring outcomes for cancer treatments and services. Under its Medicare Alliance Policy, Labor has already announced that it will establish a Medicare Commission to set national standards and get better value for our health dollar. Cancer services will be an important focus of the Commission's work.

In the first year $0.5 million will be spent producing the Australian Cancer Plan.

Prime Minister's Cancer Advisory Panel

The Prime Minister's Cancer Advisory Panel will provide the Government with expert advice on how Australia can seize the opportunities to strengthen our fight against cancer. This Panel will consist of eminent people from a range of disciplines whose job will be to develop and ensure the implementation of the Australian Cancer Plan.

The Panel will promote public participation in the discussions about how Australia should fight cancer, including what should be the nation's priorities for cancer prevention, research, screening and treatment. Cancer affects all Australians in some way and therefore all Australians will be asked to contribute to how we fight to control it.

One of the Panel's first tasks will be to bring together specialist cancer centres, cancer research hubs, public health care agencies and others to form a body of expertise, to be called the National Cancer Alliance.

The National Cancer Alliance

The National Cancer Alliance will provide a national framework to coordinate cancer control. Its role will be to encourage research collaboration between institutions, avoid duplication, assist in delivery of innovation into every State health system and provide a means to implement the Australian Cancer Plan.

The Alliance will have a central Secretariat and the resources to ensure programs are implemented in a timely fashion with adequate consultation. Most of its work will be undertaken through task groups with membership drawn from across the cancer control community.

Labor will commit $7.5 million over four years for the Prime Minister's Cancer Advisory Panel and the National Cancer Alliance.

Reducing Cancer Risk

The greatest long-term gain in the fight against cancer will be secured by seizing the opportunity to reduce the number of people getting cancer by identifying the risk factors for cancer and taking preventive action. Labor's Cancer Plan will introduce:

A Target for Smoking Reduction

The health hazards of smoking are well known and concerted efforts to reduce tobacco go back over 20 years. The proportion of adults who are regular smokers has dropped from 33% in the mid 1980's to 20.4% in 2000. Spending by the Howard Government on tobacco control has declined steadily since the 1997 "Every cigarette does you damage" campaign.

Labor will re-invigorate the tobacco control program and set a target of reducing the proportion of adults who smoke to 15% within five years. A comprehensive plan to achieve this goal will be separately announced. Funding will be increased from the current level of $2.5 million a year to $42 million over the next four years.

A National Sunsmart campaign

Australia has the highest rate of skin cancer in the world due to our outdoors lifestyle and hot climate. A generational shift has occurred in public attitudes to the use of sunscreens and covering up in the sun. However more needs to be done to reduce the future rate of skin cancer.

Labor will conduct a national campaign in partnership with the States to ensure that these messages reach the whole community and prevent a future epidemic of skin cancer.

Cancer Risk Reduction Programs

Labor will inject $9 million over four years to fund Sunsmart and other campaigns run by the Australian Cancer Society to publicise cancer risk factors and inform Australians about how to reduce the likelihood of getting cancer. Specific public awareness campaigns are needed for bowel cancer and melanoma.

A significant challenge exists to develop an meaningful nutrition message which shifts public behaviour towards diets which are of a lower risk for cancer, which also reduces the risk of other diet related diseases.

Individual cancer risk and new screening technologies

In the future there is the prospect that gene research may identify factors that affect the prospects that any individual might develop cancer and even suggest mechanisms by which those hereditary risks might be reduced. There is potential that treatments could be developed to help high-risk individuals to prevent or delay the development of cancer. Labor will encourage research and clinical trials of these emerging technologies to further reduce the burden of cancer.

Detecting Cancer Earlier

Early detection through screening programs is a critical step in successful cancer treatment. Labor will significantly boost screening programs by:

Undertaking a Queensland Melanoma Screening Trial

Australia has an opportunity to undertake a world first screening trial to detect melanoma. The Queensland Cancer Society has funded its own pilot project to get a whole town to participate in a screening survey by trained GP's to detect early melanomas. Labor will commit $6 million to fund the next phase of this trial involving 500,000 Queenslanders in 50 locations to determine the effectiveness of this approach.

Expanding Cervical Cancer Screening

Around two thirds of Australian women currently have regular cervical cancer screening - which is high by world standards. However there are significant barriers to getting other women to participate. The Government proposes to give GP's $71 million over four years to achieve a quota of screening but this approach won't adequately reach remote areas, Indigenous Australians, migrants and others who are currently under-represented. A recent survey indicates that 85% of unscreened women had been to a GP but not sought a pap smear because of embarrassment and a preference for such a procedure to be undertaken by a female doctor or nurse.

Labor will implement an alternative cervical screening program to complement the existing GP based services with community based services and outreach, targeting the women who are not currently participating. The success of the Breast Screen Australia model indicates Labor's approach will get better results in reaching more women.

Undertaking a Trial of Bowel Cancer Screening

New techniques for screening for bowel cancer have been developed which permit a simple test based on a faecal sample collected in the home.

In 2000, the Howard Government allocated $7.3 million to trial these methods but there has been virtually no progress. The first announcement of a commitment was made in the last days before the election was called.

Labor will reactivate this project and establish trials to evaluate the effectiveness of this method for early detection of bowel cancer.

Expanding Breast Cancer Screening

Australia has a good record in providing high quality free breast cancer screening for women aged 50 to 69 years. However, there is still a significant part of the target group not taking part. Increased funding will enable screening to be expanded to reach "at risk" groups.

Improving Prostate Screening

The rate of prostate cancer is increasing and it is now the third most common cause of cancer death in men. Screening using the prostate specific antigen (PSA) test is increasing. However, there are concerns about the testing methods and its relevance in diagnosis. Men with an early indication of prostate cancer face difficult choices about their treatment options. Labor will encourage measures to improve the tests for early diagnosis and research to improve the accuracy of diagnosis.

Stepping Up Australia's Cancer Research Effort

Cancer research holds the key to controlling this distressing disease. As part of Labor's commitment to building a Knowledge Nation Labor will:

Increase Total Spending on Cancer Research

In 2000, Australia spent around $16 million on individual NH&MRC cancer research projects and another $11 million in grants to major Institutes for cancer research. This represents about 13.5% of total NH&MRC research spending in that year.

Labor will maintain the commitment to double total medical research funds by 2004-5. Within this growing pie, Labor will make cancer a strategic priority for the NH&MRC. The Strategic Research Committee will be asked to advise on the adequacy of the current proportion of funds going to cancer and how the Australian Cancer Plan should be reflected in strategic priorities on research.

Specifically, we expect increased NH&MRC funding for research will assist such areas as basic cancer research, identification of individual cancer risk, new prevention methods, new screening programs, new cancer therapy and clinical trials. This

approach will provide an expanded scientific base for improvements in cancer outcomes.

Promote National and International Collaboration

The National Cancer Alliance will provide a framework for coordination of our cancer research efforts. This is necessary if Australia is to maintain its role as a major player in global cancer research. Such coordination will aim to increase research collaboration between individuals and institutions, develop large-scale projects in key areas of national importance and identify areas of deficiency in our research efforts.

Currently we undertake about 2% of all cancer research around the world. This reflects the high standard of Australian research. However, to maintain our position we must keep up with the rapid increases in investment in biotechnology being made overseas. We must also recognise that 98% of cancer research happens elsewhere in the world and therefore we must ensure we have the ability to learn from overseas and apply the latest international techniques and procedures in Australia.

Cancer Research and Development of Biotechnologies

As part of Knowledge Nation Labor will implement a series of policies to encourage investment and innovation in the biotechnology sector. New incentives for industry research partnerships in biotechnology will be established. Areas that are particularly relevant to cancer such as genomic research, new therapeutics and new diagnostic and medical technologies will be promoted.

A new series of Cancer Research Fellowships will be established to encourage our best young researchers to stay in Australia to do their work here.

Translating Research Into Practice

Translating cutting edge research into prevention, detection and patient treatment requires a commitment to greater teamwork.

Comprehensive Cancer Centres

A small number of Comprehensive Cancer Centres will be established and linked to other services to make sure that high quality cancer treatment is available throughout the hospital system. Such centres will be a focus for clinical research to allow innovation to be quickly translated into routine medical practice.

Queensland has already developed its own cancer strategy around such a centre and Victoria is working towards a "Victorian Cancer Collaboration". Other States will be encouraged to develop similar collaborative efforts or become partners in a national group.

Each Comprehensive Cancer Centre will involve a network of researchers, teaching hospitals, district hospitals and GPs and be expected to develop optimal care protocols for wider use. A team approach will be taken to the analysis of each case and

development of treatment so that optimal management of each patient is assured.

Labor will allocate $41 million over four years to support the Comprehensive Cancer Centres and promote greater collaboration.

Clinical Trials Research

Clinical trials are the most effective way to quickly test the most promising new cancer treatments and are an essential step in introducing innovation into patient treatment. In Australia, there is a weakness in our capacity to undertake publicly funded cancer trials.

Support for cancer clinical trials will be provided through additional funding to the NH&MRC for cancer trials and capacity building. Particular emphasis will be put on collaboration with national and international clinical trials groups and increasing patient participation rates through supporting clinical researchers directly. $13 million will be allocated over four years to fund clinical trials on cancer.

Improving The Treatment Of Cancer

Kim Beazley's Plan for Cancer is committed to developing a health care system that delivers a consistently high quality of cancer treatment. This will be achieved through:

Better Clinical Information Technologies

Clinical cancer databases will be progressively developed at major cancer treatment centres.

The clinical databases will complement population-based cancer registries and enable better analysis of data. Better records will be able to be kept of the treatment provided in each case and, where consent has been provided, de-identified patient information will be accessible to researchers. This will enable the care of patients to be evaluated and the quality of care to be constantly improved.

These information systems will also provide an interactive best practice framework for treating doctors.

Implementation of Treatment Guidelines

The Commonwealth will use its resources to more effectively promote the implementation of Cancer Treatment Guidelines. Cancer patients and clinicians need to introduce best practice into the daily reality of cancer treatment in a busy hospital environment. This includes ensuring there is a human touch, encouraging dialogue and involving patients in making informed choices.

More work is needed to effectively implement completed NH&MRC Cancer Treatment Guidelines and to expand their scope so patients are treated appropriately and optimally. These Guidelines will be updated and additional Guidelines developed to cover more types of cancer.

Introduction of Quality Assurance

The National Institute of Clinical Studies will work in partnership with the National Cancer Alliance to monitor outcomes and effectiveness in cancer treatments using the Clinical Cancer Registries and other information. Variations in methods and outcomes will be examined to ensure high standards are maintained. A total of $15 million over four years will be allocated to the above priorities.

Continuing Care Outside Hospitals

Patient care is at the heart of Kim Beazley's Plan to Fight Cancer and the services cancer patients receive will be improved by:

Providing Cancer Drugs at Home

One of the most distressing elements of current care arrangements for cancer patients is the difficulty people with advanced cancer have in accessing the drugs they need. Currently, if they choose to go home from hospital they currently lose eligibility for some cancer medicines provided free to public hospital inpatients. The alternative of multiple PBS scripts is expensive and some cancer drugs are not listed on the PBS.

Labor will reform the hospital pharmaceutical system to enable patients to access specialist cancer drugs as outpatients at home.

Labor will inject $15 million over four years to cover the cost of non-PBS pharmaceuticals and will allow hospitals to provide outpatients with drugs on the PBS.

Better Resources for Palliative Care

Palliative care services for dying patients are widely recognised to be under-resourced. People with cancer need access to assistance to help them through their last weeks and often prefer to do so out of a hospital setting and amongst family and friends if possible.

Labor's will allocate $15 million over four years to home-based palliative care across the States. In particular, funding of palliative care nurses and allied health staff will allow patients to stay at home if they wish.

Providing better counselling and support services to cancer patients

Patients with cancer and their carers suffer physical and emotional trauma from their disease and its treatment. Excellent information and support services are provided in this country. However not all members of the community know about them or can get access when they are needed.

There are opportunities to further develop the roles of the specialist cancer care nurse and general practitioners for counselling and coordination of care. The Australian Cancer Plan will include strategies to deliver quality services and ensure they are

accessible to all Australians coping with cancer - either as a patient, family member or carer.

Costing

  01-02 02-03 03-04 04-05 Total

Radiotherapy Machines (1) nfp nfp nfp nfp 70.0

Positron Emission Tomography scanners (2) nfp nfp nfp nfp 43.8

Australian Cancer Plan 0.5 0 0 0 0.5

National Cancer Alliance 1.5 2.0 2.0 2.0 7.5

Tobacco Control Programs 8.0 10.0 12.0 12.0 42.0

Cancer Risk Reduction Programs 1.0 2.0 3.0 3.0 9.0

Early Detection and Screening 14.2 16.0 16.3 19.2 65.7

Stepping up Research (1) 0.0 0.0 0.0 0.0 0.0

Comprehensive Cancer Centres 9.0 10.0 11.0 11.0 41.0

Clinical Trials Capacity 2.0 3.0 4.0 4.0 13.0

Clinical Cancer Databases and Guidelines 3.0 4.0 4.0 4.0 15.0

Continuing Care outside of Hospitals (3) 2.0 3.0 5.0 5.0 15.0

Subtotal 41.2 50.0 57.3 60.2 322.5 (4)

Less: Funds Currently in Forward Estimates -11.2 -20.0 -27.3 -30.2 -88.7

TOTAL (millions) 30.0 30.0 30.0 30.0 233.8

(1) Labor has committed up to $70 million from the Medicare Bonus for additional and replacement radiotherapy machines and increased staffing. The details and yearly allocations are being discussed with each State and are not for publication.

(2) Labor is committed to implementation of the seven PET scanners recommended by the national review in 1999 - including one in Western Australia. These funds are provided for in the forward estimates but the Government has provided no breakdown of the funds allocated.

(3) This amount is separate from the $18 million over four years for Palliative Care announced in Kim Beazley's Plan for Public Hospitals.

(4) This amount includes $113.8 million for Radiotherapy machines and Positron Emissions Tomography scanners. This amount is included in the total figure but is not allocated for each year. As explained above, the year-by-year allocations are not for publication. The net budgetary impact in $m is:

01-02 02-03 03-04 04-05 Total

30.0 30.0 30.0 30.0 120.0

Authorised by Geoff Walsh, 19 National Circuit, Barton ACT 2600.