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Still waiting for cancer care
Sunday, February 15, 2009
This week, cancer patient Roddy Carter is continuing his radiation treatment for advanced bowel cancer in St Luke’s hospital in Dublin. The Dublin man was diagnosed with late-stage bowel cancer after presenting with pains at St Vincent’s emergency department several months ago.

Carter had been on the waiting list at Tallaght hospital for a colonoscopy (the procedure which diagnoses bowel cancer) for a year. Each time he’d enquired about the procedure, he was told he’d have to wait.

Such was the seriousness of his condition that he was operated on within three days of his visit to St Vincent’s hospital. He needed radical surgery and is now receiving radiation therapy as follow-up. If he hadn’t taken the initiative and gone to St Vincent’s, he’d probably still be waiting for a colonoscopy at Tallaght.

Carter’s story is not an isolated one. There is clear evidence that, despite the huge investment in cancer services, and the massive improvements in infrastructure and staffing, patients with potentially serious cancers are not being diagnosed on time, due to the lack of urgency on the part of hospitals, and the failure to extend opening times to clear waiting lists.

Some 950 people die each year from bowel cancer in Ireland, the second-highest rate of cancer-related deaths after lung cancer. Ireland has the highest rate of bowel cancer in western Europe.

The country’s cancer ‘tsar’, Professor Tom Keane, has focused on closing down cancer services in smaller hospitals to ensure high-quality services in eight centres of excellence, but some of those major cancer centres are keeping patients waiting up to a year.

The Department of Health has stated that the major emphasis of the national cancer strategy is prevention and early detection, yet the lengthy delays in some hospitals mean patients’ cancers are more serious when they are eventually detected.

Furthermore, there is still no bowel cancer screening service, and Minister for Health Mary Harney has given informal indications that the serious financial crisis could jeopardise the €1million set aside to begin a national screening programme in 2009.

Two hospitals in particular, Letterkenny and Tallaght, account for 55 per cent of the 435 patients waiting more than six months for a colonoscopy on the National Treatment Purchase Fund’s waiting lists.

Last November, the Irish Cancer Society highlighted the lengthy waiting times for more than 800 patients around the country. Within two months, that number had halved. ‘‘We think that highlighting it made the difference,” said Jane Curtin, of the Irish Cancer Society.

In the Mater hospital in Dublin - one of the eight designated centres of excellence - the waiting time fell, between November and January, from nine months to one month. There were similar dramatic reductions in Sligo, Tullamore, Cavan and Monaghan hospitals.

Last week, Keane gave good news and bad news about the country’s cancer services, in a presentation to mark the launch of the Irish Cancer Society’s Daffodil Day.

The good news is that the two-year plan to centralise cancer services is ahead of schedule.

The bad news is that Ireland’s cancer survival rates are still way behind those of our western European neighbours. There is still a lot of catching up to do, while our rates of cancer are increasing as our population ages.

Almost 18 months into his two-year contract, Keane has made rapid strides in his plan to implement a quality service for the country’s cancer sufferers. In September 2007,when Keane’s two year appointment was announced, Harney insisted that 13 small hospitals would no longer carry out cancer surgery. By the end of 2008, that number had risen to 21.

By the middle of 2009, it’s likely that the target of eight designated centres doing all breast cancer surgery will be reached, despite the considerable opposition of a number of centres, including Sligo (see panel). In the coming months, breast cancer services at Tallaght, Drogheda, the South Infirmary in Cork and Sligo will be closed.

From the beginning, Keane had the political backing of the minister and ensured that funding for the National Cancer Control Strategy (NCCS) was ring fenced within the HSE budget. He addressed meetings of local political representatives and met GPs and hospital doctors who opposed his plan. He listened and argued, but stuck to his plan.

Unlike previous unsuccessful attempts at closing hospital services in small centres, he ploughed ahead, helped in part by the steady stream of stories of cancer misdiagnoses in small hospitals and poor diagnostic practices in others.

Being a relative outsider helped. He’d come on a two-year sabbatical from Canada, after an encounter with Harney on a fact-finding trip by the health minister to see how the Canadian model worked. He’d implemented radical changes to the Canadian service, and Harney asked him to come back to Ireland and do the same here.

While there is now speculation that he may continue in his job beyond next November, it is unlikely. The two-year timeframe focused minds, and the timeline worked.

‘‘Having Tom Keane there, with a designated timeframe and budget, made all the difference,” said Jane Curtin. ‘‘We’re confident that he will also move ahead with the rapid-access clinics for prostate cancer and lung cancer within the coming 18 months.”

Plans to expand radiation therapy services around the country are also continuing, but it is unclear how the economic recession will affect the rollout of these expensive and labour-intensive services. Within the next week or two, the Health Service Executive hopes to ‘go live’ with the new hospital consultants’ contract, which will involve hospital doctors in multidisciplinary teams and clinical audits.

At a press briefing on the implementation of recommendations of the Commission on Public Safety last Thursday, Harney predicted that, alongside the reconfiguration of hospital services, a new era of patient safety and accountability was beginning.

Perhaps then more questions will be asked at hospital level of doctors who still have lengthy waiting lists for vital diagnostic tests to detect early cancers, forcing the likes of Roddy Carter and others to go knocking on the doors of emergency departments to find a doctor who will treat their illness with the urgency it deserves.

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