Dubbo Weekender | Friday 20.11.2015 to Sunday 22.11.2015
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Breaking new ground Medical oncologist Dr Florian Honeyball swapped the fly in, fly out lifestyle in May this year to finally call Dubbo home. At the same time, he broke new ground to become the city’s first resident oncologist and is actively expanding services to Cobar, Walgett and Mudgee. WORDS Yvette Aubusson-Foley PHOTOGRAPHY Connor Coman-Sargent T’S a significant milestone that this year, the Alan Coates Cancer Centre Chemotherapy Unit at the Dubbo Base Hospital should have it’s own – and the city’s first – resident medical oncologist. The past six months have flown, seeing Dr Florian Honeyball settle into his new life in Dubbo while introducing regular visits to Walgett, Cobar and Mudgee, all progressive and ground breaking steps for Western NSW Local Health District (LHD). While it’s been a bit of a wait for Dubbo for his position to become permanent, Honeyball has not been idle, dedicating many years to his training and visiting the city often. “I’ve been a consultant now for this year in this field since 2011. Before that I was a physician trainee. “The training process of a doctor is you do six years of medical school, then you do an internship usually for one year, then a two year residency, then three years of basic physician training where you do every different specialty; so you do cardiology, respiratory medicine, kidney medicine; you learn about the body and it’s sub specialties. “Then you must pass an exam and then you can do advanced training on a particular specialty, so for me an additional three years o f
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medical oncology.” Initially however, Honeyball had intended to become a surgeon. “I’d always wanted to be a surgeon and then I actually did surgery and realised your interactions are forced to be a lot quicker because you’re so busy in theatres all the time. “I quite liked the interpersonal connections I had outside of theatres then I started looking at specialty areas that would afford that to me and I thought oncology was really a good outlet for that and my interest in people.” In circumstances where a patient is being treated for a life threatening illness, inevitably, they will be supported and surrounded by loved ones and friends. “Oncology is complex because you’ve also interactions with people who are patients’ friends and relatives. It makes that quite rewarding, quite enriching having so many different interactions with so many different people and I quite like that, so that’s what drew me to oncology,” he says. And… to Dubbo. “I did my training in medical oncology through Royal Prince Alfred Hospital and as a result of that I used to fly in and out as a registrar once a week, with several of the other consultants from RPA. That’s how the service was provided in the past. “Last year I was Dubbo’s first clinical fellow, so I’d spend two days a week in Dubbo on Mondays and Tuesdays and the remainder of the week I’d do cancer complex subtypes such as melanoma and sarcoma at Chris O’Brien Lifehouse which is now an outreach of Royal Prince Alfred. “I think I’ve grown to love the town over the many years I’ve been flying in and flying out, so I think my wife and I are both pretty happy. She’s a neurologist, a brain specialist,” he says. HAT’S good news for Dubbo, which serves its surrounding districts with a population of over 120,000 people. “Dubbo’s always had a desperate need for an oncologist. I was approached and I thought, why not? It seemed like a great opportunity and a big challenge as well to try to not just provide a comprehensive cancer service to Dubbo but also to the district beyond. “I’ve started going to Mudgee which is quite busy and I go once a fortnight. It is a chemotherapy unit, which is similar to what’s here but it’s only a four bed bay,” he says, describing the large lounge-chair style recliner seats. Dubbo has eight. “We’re also now providing weekly treatments whereas before it was a little bit here and there,” says Honeyball.
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“In the past if you couldn’t be sent to treat many other cancers. Particularly with some types of colon cancer and Dubbo you went to Sydney.” some types of lung cancer it’s looking Distances Western NSW cancer pavery promising.” tients do have to travel to receive treatIn the mean time, Honeyball’s role is ment has recently received attention at to work with patients after they’ve had government level. surgery. “(NSW Health Minis“We’ll have a discuster) Jillian Skinner has sion about what extra recently come up with an ` treatments would be extension to the isolated Oncology is beneficial and that can patient transport assistance scheme, so that’s complex because involve a combination of chemotherapy, radiexpanding funding for you also have otherapy or endocrine people having to travel therapy, which is horlong distances into the interactions with mone therapies. city. people who are “We’ll do chemother“We try to do the maapy and one of the horjority of treatments here. patients’ friends mone therapies, called It’s only if I think there’s and relatives. It here or in clinical trials which I makes that quite Herceptin, Mudgee. The endocrine think are beneficial then therapies can be done I will get people to travel rewarding, quite at home because they’re to Sydney.” enriching…” generally tablet-based, Keen to keep as much and we just keep an eye treatment local, Honeyon how things are going. ball is eager to conduct clinics in outly“It’s generally a year and in addition ing towns. to that the hormone therapies run into “We provide outreach services to five or ten years nowadays.” Walgett and Cobar on a second monthHoneyball says specialists are limited ly basis and that’s really to try to avoid to a certain degree as to what chemopeople doing the 300km trip each way therapy they can give outside of Dubbo. for a ten minute appointment to see “Some chemotherapy need an ICU how their breast cancer is going or their prostrate cancer or if they’re only com- and emergency backup just because of the risk of the reaction, which is very ing once a year. rare. In the entire time I’ve been here “I see that as a big growth area down over the last three years, we’ve only the track.” needed it once but on that one occasion Staying on top of cancer treatment init was needed. If we’d been doing a siminovation, Honeyball will implement inlar thing in Cobar it might have been a novation where he can. different outcome.” “Treatment perpetually changes. In While statistics show the prevalence breast cancer specifically, the most comof cancer is a little higher in rural areas, mon types of chemotherapy which you Honeyball suggests they don’t paint the would give for advanced early breast whole picture. cancers – the higher risk early breast “The statistics are a little more difficancers – has changed completely in cult to compile because I think there’s the past four years, so it’s continually also a lot of under reporting, particuevolving.” larly if someone presents far away from “In some other cancer types, specifiDubbo and doesn’t want to travel down cally melanoma, even in the past year, or have investigations so their canthings have changed very dramatically cer may actually never be diagnosed. I from people having not so great an outthink there’s a degree of underreporting come, to now having amazing quality and also difficulties in accessing treatand quantity of life, which was unimments at diagnostic facilities.” aginable even two or three years ago. To tackle this issue, Honeyball is at“People with advanced melanoma on average would die within about six tempting to get a PET scanner installed in the region. months but nowadays it’s the norm to “One of the big pushes I have at the keep people alive for years, many years, with the new check-point inhibitors, moment is trying to get a PET scanner somewhere in the district. That way we and they have quality of life for those can diagnose closer to home. It would years as well.” be a fixed device somewhere in the local health district rather than having peoCheckpoint inhibitors currently hold ple travel into Sydney for this diagnostic the key to cancer treatment potential, test. That’s one of our projects. Honeyball says. “We do need funding for that and “It’s new chemotherapy-like check we’re approaching different sources at point inhibitors which have revolutionthe moment. Dubbo West Rotary is inised melanoma care and is probably volved in that push as well.” in the front seat to change the way we