How to continue my ongoing oncology care in SYDNEY??

Clara

Hi!
I was diagnosed and treated for early stage breast cancer (DCIS grade 1, ER+ PR+) at 29 y/o, a few months ago, in Sweden where I work. I had planned to move to Sydney in September (my husband got a job there) but before doing so, I need to make sure that I can properly continue my endocrine treatment in Sydney:
1) Anyone knows what is the fastest/cheapest way to get my Letrozole prescription +injections of Zoladex (Goserelin) every 4 weeks? I need to make sure that I can get the injections on time once I moved to Australia. I found the cost of both medicines on PBS website but what is the cost of the doctors appointments (to prescribe and to inject Zoladex)?
2) Is it also required to do a blood test (to check hormon levels) every months when you take Zoladex?

Note: I am not Australian but I will get the yellow Medicare card (due to a health agreement between Australia and Sweden).
Thanks in advance for your help!!
I hope I will be able to relocate to Sydney and live my life as before...

Zoffiel

Hi Clara,
A General Practitioner can prescribe the Letrazole but I am not sure about the Zolodex. Depending on where you go, out of pocket costs can be up to $50 if the practice charges $85 per visit, which some do. There are often community health clinics who bulk bill; the down side of that is you often get little choice about who you see.
You probably should find an oncologist when you settle in since your cancer was quite recent, in fact I'd expect a GP to recommend that straight away. The cost to see them can be eyewatering soso  pays to shop around as there variances in charges, there are also public services who bulk bill. Mxxx

kmakm

Hi Clara, and welcome to Australia, well a virtual part of it anyway!

First you'll need to see a General Practitioner, which everyone here refers to as a GP. This is as simple as a Google search 'GP near me'. The costs are as @Zoffiel says above. If Sweden has a reciprocal health care agreement with Australia, add 'bulk bill' to that search and you will see a doctor for free.

Your GP will refer you to an oncologist. This is a formal process where you are given a letter to take to the oncologist. If you like the oncologist and are happy to work with him/her, you can ask your GP for an indefinite referral so you don't have to keep getting a referral every few months.

I am about to start Letrozole on Friday. I was still menstruating when I was diagnosed so my oncologist has told me that I will have a blood test every three months to see what my FSH & LSH levels are. If they're trying to start my periods again I'll have a Zoladex injection every month. Given your age I'd say you will definitely have blood tests but I couldn't say the frequency.

Seeing a private oncologist will definitely cost you money. Again, with the reciprocal agreement, you may be eligible to see an oncologist in the public system. However it removes choice and there may be waiting times.

Good luck with the move. I hope it all goes smoothly, and that life in Australia will be good! Let us know how you get on. Kate xox

Romla

Hi Clara this maybe obvious but could you bring a letter from your doctor regarding your treatment , your medical records and your latest prescriptions ? It may save time and help get your treatment back on track faster.Usually you can get into an oncologist fairly quickly -hopefully some Sydney people will come online soon and give you recommendations. Welcome downunder and glad you found the blog - keep in touch.xo

Annski

Hello Clara welcome here. Sydney is a very big city with many different quality services. What's best to do depends a bit on where you live. If you want to access public services especially for your oncology treatment you need to go to a GP in the relevant area so it will depend on your address. Any GP can prescribe Letrozole although you should bring notes from your treating doctors in Sweden. . Public cancer treatment centers are mostly very good. If you are able to live in the Inner West you can ask the GP to refer you to the Chris O'Brien Lighthouse Centre at the Royal Prince Alfred Hospital in Camperdown. They offer a complete service and take public patients. However the timing of your Zoladex might be a problem if there is a waiting time for the onc o clinic. Discuss it with whichever doctor you first see. Send me a personal message if you know where you will be living when you get here and I can send more information. I have had mastectomy radiation and oncology as well as several other major surgeries at different places  both public and private. If you can afford private care for your oncologist my recommendation would be different.
I hope you can settle in here and wish you well.

Clara

Thanks a lot for your answers and advice! I understand a bit more of the Australian health care system now.

I got contradictory information about Medicare today so I'm actually not sure if I will be able to access the public system. 
That's why I'm trying to estimate the full costs of everything without any public or private subsidies (because no private insurance will cover me during the 1st year due to preexisting condition..). If we can afford these costs, we will happily move in September! 

Here are the full costs (without Medicare, nor private insurance) that I found:
- GP consultation up to $85 (thanks @Zoffiel !): GP may directly prescribe Letrozole+Zoladex and give me a referral to an oncologist. I will bring a copy of my medical records in English to hopefully speed up the process (thanks @Romla). 
- Nurse consultation to inject Zoladex 1/month and blood test (to check FSH & LSH levels). @kmakm maybe you know about these 2 costs?
- Oncologist consultation: I have read $200-350 but that sounds insanely expensive (at least for my European-free-health-care mind talking here! ), is it correct? How long is the waiting time for that cost?
- chest MRI: I was told $350-550 out of pocket but what is the full cost if I don't have Medicare?
- mammogram: $100 out of pocket. What is the full cost without Medicare?
- chest ultrasound (complementary to mammogram, necessary at my age): cost?

I know that costs are very different from clinics to clinics but I just need to know average costs in the private system (I guess I cannot access public hospitals if I don't have Medicare) based on your experience. 
@Annski I sent you a message, thanks for your recommendation in Sydney! We will probably live in the Inner West.

Looking forward to your answers, thanks again for your support!! 
I really hope I manage to get the cost information needed to make this life project come true I studied in Melbourne 10 years ago and I really loved the aussie people/atmosphere so I cannot wait to be back! 

Zoffiel

Oncologists fees range from about $170 per visit upwards. There is usually a premium on the first visit as it is likely they will need to spend more than ten minutes with you. Good thing is once you get the Zolodex sorted you may be able to avoid them for months and just get the script renewed a couple of times. They do like their money, so be wary of over servicing. 

www.mbsonline.gov.au is where you will find what the government considers the scheduled fees. It's a shit of a site, sorry. See if you can find the category book number 5.  I'm on my tablet and have never figured out to copy and paste to here and it won't let me attach a PDF doc. Anyway, that tells you the rebate on all sorts of procedures towards the end of the document. The catch is, the schedule has not kept up with the charges as there is no obligation to charge the recommended fee.

Kiwi Angel

@Clara. I have a good oncologist in Sydney - Carole Harris at St George Private in Kograh - she also runs The multidisciplinary team at the hospital with all the doctors, nurses, pathologists, surgeons and breastcare nurses. Her initial consult was $300 and I got some back from Medicare and the ongoing appointments are not approximately $90 by the time I get my Medicare rebate. 

kmakm

BCNA Moderators, perhaps this is something you could help Clara with? What are the reciprocal healthcare rights between Australia and Sweden?

Clara, it might be possible to get some information on this from the Australian embassy/consulate in Sweden. Have you tried them?

Not up to needing Zoladex yet so I'm sorry but I can't help you on this front. K xox

Sister

I thought I posted something similar to bcna admin but it's not here so I must have done something wrong.  

The other thing about private care here, Clara, is that it never hurts to ask if there's negotiation on the finance front (doesn't help with upfront planning, though).

Riki_BCNA

Hi @Clara The following website provides some information regarding reciprocal health care agreements with Australia that may answer some of your questions https://www.humanservices.gov.au/individuals/services/medicare/reciprocal-health-care-agreements/visitors-australia/medical-care-visitors-australia#a2 Please do not hesitate to contact the Helpline at BCNA on 1800 500 258 if you have any further questions.

Clara

Thanks a lot for the tips and information! 
I will try to go as a public patient in the Royal Prince Alfred Hospital (in the long term) and I'll look for a private hospital (recommendations are welcome ) to start with as soon as I arrive in Sydney, to avoid interruptions in my Zoladex treatment (every 4 weeks).

I contacted hospitals and tried to know the costs (as a private patient, in case I cannot be a public patient), I received only one answer:
- chest MRI €550
- mammogram +ultrasound $600
- oncology consultation $340 then $160/visit (but I don't know how often I will have to go...)
I hope this is correct so I can plan accordingly.
The last info I would need is how to get the Zoladex injection and how much it costs (I assume that the GP will be able to do it or to refer me to a nurse without a long waiting time)

Thanks again for your help! And feel free to message me directly if you have any recommendations of hospitals/oncologists in Sydney