Cancer treatment centres on location

Caroline O’Doherty reviews the National Cancer Control Strategy, which provides the opportunity to see whether specialist centres are the best means to survival.

A STATISTIC beloved of health professionals is that cancer patients treated at large, specialist centres that see many hundreds of cases every year have their chances of surviving the disease boosted by 20%.

Finally, it seems, they’re going to get a chance to prove it.

The first major step in the long-planned National Cancer Control Strategy was taken yesterday, with the designation of eight regional cancer centres based at existing hospitals which will soon become the only public hospitals allowed to treat cancer patients.

How soon depends on a number of factors. Cancer services provided at many smaller local hospitals have to close first and be transferred lock, stock, staff and barrel to their nearest regional centre and that’s a process that will surely not happen without logistical hiccups and practical problems with a bit of industrial relations strife thrown in.

However, say everything does go to plan, here’s how the Department of Health and the Health Service Executive (HSE) see their strategy working: there will be four ‘cancer control networks’, each comprising two existing large hospitals or ‘centres’, each with a population base of half a million. This population-based approach to locating cancer services inevitably means Dublin gets the lion’s share. The cancer control network for the HSE South area will consist of:

Two centres, at Cork University Hospital and Waterford Regional Hospital.

HSE West will have centres at University College Hospital Galway and Limerick Regional Hospital.

HSE Dublin/North East will have Beaumont and the Mater (both in Dublin).

HSE Dublin/Mid-Leinster area have St James’s and St Vincent’s University Hospital (both in Dublin).

Each centre will offer a very wide range of services, from diagnosis to treatment to palliative care with links to social workers, psychological services and other supports. The exception is radiotherapy which will only be offered at six of the eight centres, with the four Dublin centres expected to share two units.

Not every centre will treat every type of cancer, apart from breast and colon cancers which will be served by all eight. Other common cancers, including lung, testicular, gynaecological, colorectal, skin and urological cancers will each be treated at four centres (one in each HSE area) while less common cancers of the oesophagus and stomach will be treated at just two centres.

Liver, pancreatic, brain, spinal cord, head, neck, bone and paediatric cancers will each be confined to one centre. Details of which centre will treat which cancer have not yet been released.

There will be just one exception to this highly structured plan. Letterkenny in Co Donegal is to get, not a fully fledged centre attached to a major hospital, but an outreach centre linked to University College Hospital Galway in deference to the geographical isolation of the population there.

Chief executive of the HSE Professor Brendan Drumm, however, stressed the exceptional status of the area. “I would ask that people will not take this as open season in terms of raising claims for outreach centres in other areas.”

His warning anticipates a likely reaction in communities soon to lose cancer facilities from their local hospital. Yesterday, 13 smaller hospitals were ordered to stop providing breast cancer services with immediate effect: Naas General; Tullamore General; St Columcille’s, Loughlinstown (Dublin); Mallow General; Louth County; Cavan General; Our Lady’s, Navan; Mid-Western Regional, Nenagh; Ennis General; St Michael’s, Dun Laoghaire (Dublin); Roscommon County; Portiuncula (Galway); and Mercy Hospital Cork.

Most of these hospitals were seeing less than 20 breast cancer patients a year, far below the 150 recommended as necessary for a cancer team to remain proficient in their work, and the HSE officials making yesterday’s announcement were at pains to stress that some had already ceased breast cancer services without any fuss, although they couldn’t say which ones.

Within the next 90 days smaller hospitals providing services for other types of cancers will also get the tap on the shoulder, although the HSE said it had yet to identify which hospitals and which services it would be targeting. The end result of these closures should be that the services they provide, the staff who provide them and the funds that support them, will all transfer to the eight large centres by the end of 2009.

It is particularly ambitious given the determination that it should happen largely from existing budgets, through the redeployment of staff and resources rather than additional investment.

Some of the transfers will unavoidably have bricks and mortar implications and there was an acknowledgement that some extra financing would be needed. However, chairman of the working group that designed the cancer control networks Tony O’Brien said: “We cannot tell you what the total cost will be.”

The cost in human terms will need to be delicately balanced. Professor Drumm admitted the shake-up would present “challenges” for personnel working in cancer services outside the eight designated centres.

For communities, there will be a natural unease at seeing a cherished local medical facility lose some of its clout and, for patients, there will be longer journeys for treatment. The promised prize, however, is this 20% improved chance of surviving a disease that terrifies and debilitates.

The HSE and the Department of Health just need to prove to patients, the public and medical professionals alike that it’s a prize that’s worth the pain.

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