Mr BELL (Mount Gambier) (12:48): I move:
That this house—
(a)acknowledges the valuable support provided by breast care nurses to women who are experiencing breast cancer;
(b)recognises the importance of the use of lymphedema compression garments in the treatment of lymphedema; and
(c)Calls on the state government to introduce a scheme that subsidises the cost of lymphedema compression garments.
The Cancer Support Group in Mount Gambier offers assistance and support to people who are undergoing or have undergone treatment for cancer. Organisations like these, which are mainly run by volunteers, are vital to our region and are a lifesaver to someone facing a cancer diagnosis. Cancer affects everybody, and it is a fact that the older you get the more likely you are to be affected by several types of cancer, including breast and prostate cancer. One in 10 South Australian women will develop breast cancer before the age of 75.
Once treatment is complete, cancer survivors often face developing a condition called secondary lymphedema. Secondary lymphedema can occur when lymphnodes are removed during surgery or damaged from radiation therapy. It is a chronic condition that causes swelling in parts of the body, mainly the arms or legs. It is caused by an accumulation of lymphatic fluid caused by a problem or blockage of the lymphatic system.
In severe cases it is very painful and can affect the patient’s ability to use their affected limbs, work and live a full life. It is important to recognise that this is a lifelong condition. There is no cure. The rates vary for different types of cancer, but it is estimated that around 20 per cent of people treated for breast cancer will develop secondary lymphedema. The condition can occur months or even years after treatment has finished. In order for patients to live a normal and comfortable life, the condition is managed using a range of therapies including physiotherapy, medication and lymphatic massage.
However, on a day-to-day basis, most patients rely on compression garments to bring the swelling under control. These are tightly fitting elastic garments that compress the affected area and stop the fluid from building up. To do their job these garments have to be professionally fitted and a patient needs two garments—one to wear and one to wash. Some patients also require an additional garment to wear at night. Worn every day, the life of these garments can be around six months each, so each year the patient has to replace them.
Depending on how many garments you need and the severity of the condition, the costs can range from $200to more than $3,500 per year. Over a lifetime, this can add up to thousands and thousands of dollars, tens of thousands of dollars. This means that many patients do not replace the garments when they need to, which can lead to health complications such as skin infections and, more seriously, cellulitis. An international study conducted by the Lymphedema Framework in Australia found one of the key issues to improve the treatment and management of the condition was addressing the high cost of compression garments. After paying out thousands and thousands of dollars for cancer treatment, you can imagine how this would be an additional cost burden at a time when most people would be struggling financially.
Mount Gambier’s Dulcie Hoggan was diagnosed with stage 3 breast cancer in October 2015. A month later, she had a mastectomy and 23 of her lymph nodes were also removed. She underwent six months of chemotherapy and five weeks of radiation therapy. Dulcie’s attitude was positive: cope with the cancer, cope with the radiation and then cope with whatever comes later. During the radiation therapy, her hand went numb—an early sign of lymphedema. She developed the condition in her right hand, arm and underarm and was told she would have to get fitted for compression garments. She wears two—one on her hand and a sleeve—and she has a separate garment for night-time.
In the past year, Dulcie has paid $1,600 for her garments which have to be specially ordered from Germany. The garments shrink with washing and, after a few months of daily wear, the stitching starts to fray. She is currently on her third daytime set in a year. To fit them under her clothes, Dulcie cuts her right sleeve open and then re-stitches it. Dulcie just considers herself lucky to have survived cancer and lucky that her lymphedema is confined her right arm. She is still able to work. Some people who get a serious case are not able to walk properly, let alone work. Dulcie works as a customer liaison officer at the Mount Gambier Target and had to take 13 months off work to get back on her feet.
Although Dulcie lives in Mount Gambier, she was treated at the new South West Regional Cancer Service in Victoria and her treatment was bulk billed. Mount Gambier sits right on the South Australian-Victorian border. If she lived just 20 kilometres away across the Victorian border, her compression garments would be subsidised. South Australia is the only state in Australia that does not subsidise these garments. In Victoria, eligible patients can purchase up to six compression garments each year, with 40 to 60 per cent of the garment’s cost subsidised. In the ACT, patients can purchase two garments per six-month period, and 100 per cent of the costs are subsidised.
Monique Bareham is the President of Lymphedema Support Group South Australia. I think Monique is in the gallery today. She tells me that they, in conjunction with the Australasian Lymphology Association, have been lobbying for a state scheme for more than two years. In 2017, she met with then ministerfor health, Jack Snelling, who said he would talk to SA Health to develop a business case for the subsidy scheme and also for a dedicated public lymphedema treatment clinic for the state. It was expected to be included in this year’s state budget but thenobviously there was a change of government.
I agree with Monique when she says that this is a basic issue of inequality for South Australian patients. Monique is 47 years old and has lived with lymphedema for eight years. This is a battle she is taking on behalf of every South Australian with lymphedema. Some private health insurers offer small rebates for compression garments but limit the rebate to once every few years. Mount Gambier’s Pam Moulden has been privately insured with Medibank for 40 years and is waiting until April next year so that she can claim some rebate. Pam is now 69. She has had breast cancer twice in the last four years and has had a bilateral mastectomy.
After the treatment, she developed a severe case of lymphedema in her right arm and describes the pain as horrendous. She cannot hold anything in her affected hand and struggles to write. She wears a full-sleeve garment and has had to replace it several times before the holes and stitching come apart, which makes the garment less efficient. Pam has also developed fibrosis in the arm, which now requires further medical garments to be worn at night. Pam and her carer husband, Ian, are pensioners and have had to plan for the cost of the garments months in advance.
Many people in need of support are being left out of pocket. A diagnosis of lymphedema often comes at a very difficult time for people both financially and emotionally. At the end of a long and torturous treatment for cancer, when someone is trying to get back on their feet, paying for these garments is just another cost they have to deal with. An estimated 300,000 Australians will deal with lymphedema at some stage in their life. I ask the state government to introduce a scheme to subsidise the cost of these garments to bring South Australia into line with other states. This measure will have flow-on benefits to the state’s healthcare system. Best practice protocols indicate that early intervention and treatment of the condition in its early stages is vital to reduce the long-term physical and psychological impacts. Compression garments are an important part of this early treatment.
If lymphedema goes untreated, it can cause a serious health condition known as cellulitis, which often requires hospitalisation. The impact on the Australian health system from complications arising from lymphedema is enormous. It would be far more cost effective for the state government to subsidise compression garments and ongoing therapy than having to support patients during hospital stays. Icould go on and on, but I know that there are two other speakers, so I am going to conclude here and put the rest of my speech on my website.
The Hon. G.G. BROCK (Frome) (12:57): Again, as the member for Mount Gambier has indicated, I will be very quick. I want to support everything the member for Mount Gambier has said here today about lymphedema. All women undergoing surgery for breast cancer should be informed of the risk of developing lymphedema. Services and information are really lacking in regional South Australia.
I especially highlight the great voluntary work being carried out by a small group of people, with special mention of Monique Bareham, who herself has suffered pain and is now advocating for a subsidy for the special clothing for thesepeople to assist with their suffering. As the member for Mount Gambier said, South Australia is the only state not to have a garment subsidy.
Back in August this year, I wrote to the Minister for Health asking for the Marshall Liberal government to reinforce its commitment to progress development of a business case for the compression garment subsidy and designated public lymphedema services, and I have had no response at this stage. Again, I urge this state government to establish a garment subsidy for sufferers of lymphedema.
Mr DULUK (Waite) (12:58): I rise to also acknowledge the member for Mount Gambier’s motion and I fully support it. In the lead-up to the election, I was door-knocking in Belair, as I quite often do, and I came across a lady who was passionate about this issue, and we certainly talked about it. I cannot stress enough the importance of it and awareness of it. I also call for this government to play its part in assisting all South Australians with lymphedema.
Mr PICTON (Kaurna) (12:59): We support the motion and thank the member for putting it forward. I have met with the lymphedema support associations and we support their call for subsidies. There was a business case in development; the government would have that business case now and they should release it, and we believe that they should take action on this, as other states have done.
Mr BELL (Mount Gambier) (12:59): I would like to thank all members who spoke on this matter and proceed to a vote.
Sitting suspended from 12:59 to 14:00.