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Friday 9 December 2016

Priscilla Lynch: Cancer care is far better now - but it's not world class yet

There is probably nothing more dreaded or feared than cancer. Once a person gets that diagnosis, it can seem as if life has stood still.
There is probably nothing more dreaded or feared than cancer. Once a person gets that diagnosis, it can seem as if life has stood still.

Patients on trolleys, excessively long waiting lists, staff shortages, and budget overruns are the big issues currently dominating our health news headlines.

A decade ago it was stories of tragic cancer misdiagnoses, long waiting lists for cancer surgery, poor outcomes and outdated cancer care facilities.

However, you rarely see our cancer services in the headlines now – and for good reasons.

Huge strides have been made in reorganising and improving cancer services in the last decade.

In a rare success story of successful Irish health service reconfiguration, our cancer services were dramatically overhauled, starting back in 2007, with an expert from Canada bought in to oversee the dramatic plan.

Excellence

The move saw our fragmented cancer services concentrated in large centres of excellence and removed from smaller, more isolated hospitals.

Sure, there was plenty of controversy surrounding some of the reconfiguration plans – something that local politicians latched on to, making promises they could not keep over retaining services in their areas, even if they were not in the best interest of patients.

However, despite the greater distances to be    by rural patients, it is now widely acknowledged that the reconfiguration of our cancer services has largely been a success.

There are now set national protocols for when suspected cancer patients are to be referred for tests, and targets for how long they should wait for diagnosis and treatment – targets that are largely met, which we know because regular data is published on each of the centres.

Multi-disciplinary team decision-making is also now standard practice in all cancer centres, and many of the clinicians who deliver cancer care in Ireland have trained in the best cancer centres in the world and have bought back cutting edge knowledge and practices with them.

On the whole, Ireland has good access to the latest drugs for cancer, and Irish cancer patients are also regularly involved in trials for new treatments. We now also have national screening programmes for cervical, breast and colorectal cancer.

While it can take years to actually determine if improvements in access and services translate into improvements in survival, the latest statistics from the National Cancer Registry of Ireland show that the majority of Irish cancer patients now survive the disease for at least 10 years.

Four out of five people with skin melanoma or prostate cancer, and almost three-quarters of those diagnosed with breast cancer, will be alive a decade after their diagnosis.

However, it is not all good news. Last year, an international study found that Ireland has lower five-year survival rates than the European average for many cancers, particularly of the colon, ovary, kidney, stomach and lung types. Many types of cancer, most notably skin cancer and lung cancer in women, are also increasingly being diagnosed in Ireland.

Thus, there is still much work to be done before we fully achieve a world-class cancer service, with survival rates on a par with the best in the world.

Funding

We need to ensure HSE funding continues to provide the best, most up-to-date equipment and access to proven new medical treatments. Patients also need to be provided with medical cards and other support services where appropriate.

In 2014, the Irish Cancer Society’s financial support programme provided just over €1.5 million in funding to 2,368 cancer patients. Of this, 21pc (€320,000) went towards transport, showing that cancer care needs to go beyond medical services.

More than 20,000 people in Ireland are diagnosed with cancer every year, and it remains one of the main causes of premature death. Being told those three words – ‘you have cancer’ – is still one of the things people fear most but at least we can say that, despite all its faults, our health service does provide good, equitable cancer care.

Priscilla Lynch is Editor of the Medical Independent

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