Breast cancer services meet overall standards
A two-and-a-half year review of services at the state’s eight designated cancer centres, found all meet a number of essential requirements including:
* Triple assessment, a clinic at which clinical examination, mammography/ultrasound and pathology tests are carried out.
* Multidisciplinary care.
* Core staffing and appropriate equipment.
The review, published yesterday by the Health Information and Quality Authority (HIQA), said “great strides had been made, but these need to be embedded and made sustainable”.
Three hospitals – Cork University Hospital (CUH), the Mid-Western Regional Hospital in Limerick and Waterford Regional Hospital – were singled out as being in need of further on-site reviews by HIQA this year, but overall, the picture was positive.
HIQA chief Dr Tracey Cooper said the changes made to improve symptomatic breast disease services “should be used as a template to be adapted and modified for other services”. This was supported by the Irish Cancer Society.
HIQA did, however, raise a number of concerns, including the high rate of patients with benign disease being referred to these centres. Between January 1 and August 1, 2009, 16,654 patients were referred, just 957 of these had malignant breast disease.
Nationally, an average of 17 patients with benign disease were seen for every one patient with breast cancer. This ratio was highest in Letterkenny General Hospital at 37:1.
Director of healthcare quality and safety with the HIQA, Jon Billings, said the centres needed to look at whether there were other ways of streaming patients “so that those without disease do not have to go through the same rigorous interventions as patients with cancer”.
“It can create workload difficulties when you are trying to put all patients through a single treatment pathway,” Mr Billings said.
Referral rates were higher in areas without breast screening. GP patterns of referral also varied.
Tony O’Brien, interim director of the National Cancer Control Programme said they had seen a 50% increase in the number of non-urgent referrals over the past two years, while the number of diagnosed cancers remains static.
“HIQA have correctly noted that this is an issue which has to be addressed,” Mr O’Brien said.
HIQA also found the Mater Hospital in Dublin had difficulties in meeting the target of referring nine out of 10 breast cancer patients for surgery within 20 days of diagnosis; instead just five out of 10 patients were referred.
HIQA said at the time of the review, the locum consultant surgeon did not have a formal theatre access time and the symptomatic breast disease service had no ring- fenced surgical inpatient beds available.
A six-month delay in having an annual mammogram was reported in one incidence.
HIQA also found no evidence that any patient outcome information was being shared between the designated centres “to facilitate comparisons in order to drive improvements nationally’.
It also said there was no evidence of a nationally- agreed definition of delayed diagnosis, or a consistent approach across the eight centres, for clinicians, to audit and report clinical incidents.
HIQA made 18 recommendations, many of which the HSE said have already been implemented.
Health Minister Mary Harney welcomed patient input into the report.
