In this blog, Dr Kirsten Gormly reflects on RANZCR’s recent advocacy work to amend the rebate for MRI item 63476, allowing rectal cancer patients to receive an MRI of the pelvis for initial staging, restaging and follow-up as clinically indicated.
It’s estimated that over 4,555 Australians were diagnosed with rectal cancer last year (The GI Cancer Institute).
When a patient is diagnosed with rectal cancer, an MRI is critical to identify those patients who can go straight to surgery, and those who will benefit from initial chemoradiotherapy (CRT) +/- chemotherapy. Clinicians have been actively using MRI following diagnosis of rectal cancer in Australia since at least 2005, and in 2009 a Medicare rebate was introduced for a staging MRI of the pelvis, with a once in a lifetime patient restriction.
“The initial MRI rebate reflected a new paradigm for the primary staging of patients with rectal cancer and the need to use imaging to guide treatment,” said Dr Kirsten Gormly, RANZCR member and former Chair of the Abdominal Radiology Group of Australia & New Zealand (ARGANZ). Based on MRI results, patients with poor prognostic factors are usually treated with neoadjuvant CRT +/- chemotherapy before surgery. Patients without these features often go straight to surgery. By 2020, there was further global advancement in the management of rectal cancer.
“A significant proportion of patients treated with CRT +/- chemotherapy had no disease left at surgery, with the potential to avoid surgery and enter a surveillance program called ‘watch and wait’. In the case of rectal cancer, surgery is invasive and can impact a patient’s quality of life, such as needing a colostomy bag for the rest of their life. A restaging MRI is needed with clinical assessment, to identify those patients who may be able to avoid surgery.”
“Approximately 50% of patients with rectal cancer are offered neoadjuvant treatment and would benefit from a restaging MRI. Of those approximately 40% would be eligible for a ‘watch and wait’ approach, potentially avoiding surgery.”
Best practice for monitoring patients on ‘watch and wait’ involves regular clinical assessment with sigmoidoscopy and an MRI scan to detect any tumour regrowth.
“There was no funding for restaging or follow up MRI, so many patients were having to pay, adding additional stress and financial burden. Some patients paid out of pocket, others had scans in a clinical trial setting, or through public hospitals.”
“Current evidence recommends three monthly MRI scans for the first one to two years, and then six monthly up to year five. The long-term data beyond five years is not available yet, but we do know that most patients who have tumour regrow, will regrow in the first one to two years."
“It’s estimated around 70% patients will not regrow tumours and they can avoid severe health complications from surgery that will impact their quality of life. For the approximately 30% who will regrow, it's absolutely critical they receive ongoing MRIs in addition to the clinical assessment to detect the cancer early enough to have appropriate surgery.”
Through consultation with colleagues, research and clinical practice in Adelaide, it was startingly clear to Dr Gormly that access to MRI was needed for patients with rectal cancer beyond the once in a lifetime cap. Dr Gormly collaborated with Dr Liz Murphy, former President of the Colorectal Surgical Society of Australia & New Zealand (CSSANZ) and asked RANZCR to advocate their case to the Department of Health and Aged Care (DoHAC).
RANZCR worked with Dr Gormly and consulted with the DoHAC to put forward an amendment to the Medical Services Advisory Committee (MSAC), an independent committee appointed by the Australian Federal health minister to advise the government on public funding for health services and technologies. Following ongoing collaborative advocacy efforts by RANZCR staff, Dr Gormly and Dr Murphy, the MSAC approved the expansion of MRI item 63476 in November 2024, giving full access to MRI scans of the pelvis for rectal cancer restaging and patients on a ‘watch and wait’ surveillance program.
“The amendment to the MRI rebate is very important for rectal cancer patients to keep up with the change in treatment options. This change will reduce unnecessary surgeries and improve quality of life for many patients. It also reduces significant financial burden and stress for patients who would otherwise need to pay for an MRI themselves.”
Dr Gormly continues to advocate for the profession and patients, and she says its crucial for RANZCR and its members continue to represent the needs and interests our profession and patients. “I'm very passionate about radiology and clinical collaboration to improve understanding of where medical imaging fits into the patient’s journey.” “Australia continues to be at the forefront of medical imaging advancement, and we have a crucial role as partners in clinical care to ensure patients receive expert care and improved outcomes.”