Why regional patients with lung cancer are less likely to survive than those diagnosed with the same cancer in capital cities is a question Dr Wasek Faisal is desperate to solve - not just for his own patients in Ballarat but those worldwide.
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The Grampians Health lung cancer specialist is determined to uncover not just the tumour-related factors that contribute to poor outcomes, but patient factors and health service factors as well.
His study will use data collected on regional lung cancer patients in the Grampians region over the past six years, which is believed to be the single largest regional lung cancer database in Australia.
"Our study will combine tumour-factors, patient-factors and health service-related factors to develop a tool that identifies patients who might be at risk of poorer outcomes and creates the opportunity to co-design a solution to address this at a system level," Dr Faisal said.
Dr Faisal's project, funded through a grant from the Thoracic Oncology Group of Australia (TOGA), is one of a host of research projects and clinical trials - more than 50 at last count, that Dr Faisal has been principal investigator of.
The research will focus on developing a clinical "score" for metastatic non-small cell lung cancer (mNSCLC) that identifies patients at risk of a poorer outcome, and find solutions in regional settings to help change the system.
"Non-small cell lung cancer is the fifth most common cancer in Australia and despite this, the mortality rate is the highest among all cancers," Dr Faisal said.
The mortality rate remains high despite lung cancer treatment changing dramatically over the past five years with new treatments - many resulting from clinical trials around the globe.
He said it was vital that regional health providers such as Grampians Health were part of cutting-edge clinical trials.
"There's this general perception both among clinicians and lay people that you don't get world quality research or access to world quality treatment unless you're in a large metropolitan centre and that's obviously incorrect but to break perception you have to do world class research locally," he said.
"The biggest benefit for the community is that clinical research and clinical trials give access to more treatments ... if you can bring that option closer to home it means people don't have to travel to metropolitan centres. That's a benefit to the community, patients and families who get the best treatment closer to home."
He has been running clinical trials at Grampians Health since 2017.
Dr Faisal's contribution to lung cancer research, knowledge and treatment has been recognised with the Royal College of Oncologists in Edinburgh recently awarding him a fellowship.
He said the fellowship would help create "more visibility as a clinician and researcher", adding to his credibility when looking to collaborate with other researchers and institutions on cutting-edge research.
"The field of oncology is a rapidly evolving field. Unless you stay at the cutting edge it's easy to fall behind therefore patients miss out," Dr Faisal said.
Lung cancer rates continue to increase, despite smoking rates falling. One in six cases of lung cancer occur in non-smokers.
Dr Faisal said the stigma attached to smoking and lung cancer meant many cases were not picked up until they were more advanced.
"Part of that is because patients present late," he said.
"There's a lot of stigma around lung cancer patients who often don't seek help in a timely manner."
Smoking, exposure to passive smoke and exposure to other occupational carcinogens are among the factors driving lung cancer rates and there is also a genetic component among some ethnic groups.
Unlike screening for many cancers which dropped off during COVID resulting in many cancers going undiagnosed until much later, the increased respiratory awareness of people during the pandemic actually resulted in more testing and more lung cancer cases diagnosed.
