Cancer care in Ireland: 'Enormous' progress made, but more to do

One in three of us will develop cancer during our lives. And despite the many treatment advances in the field, cancer remains one of Ireland’s top killers. Which makes the once in a decade publication of a novel cancer strategy an important event for all of us.

Much progress has been made since the 2006 report. As Prof John Kennedy, chairman of the steering group responsible for the latest strategy, notes, establishing a National Cancer Control Programme (NCCP) in 2007 was pivotal. It and the embedding of cancer screening programmes in the healthcare system and the significant improvements in delivery of radiation therapy have delivered continuing improvements in outcomes for Irish people with cancer.

However, “we are now faced with a different set of opportunities and challenges”, he says. “Improving therapies have gratifyingly resulted in a greatly increased number of people who have survived cancer. Breathtaking advances in basic and translational science have resulted in a proliferation of novel diagnostics and therapeutics and this trend will continue. Such advances present great opportunities, but their integration into cancer care will present organisational and financial challenges.”

Strengths of strategy

One of the strengths of the 2017 cancer strategy is that it recognises the need to set short, medium and long term goals: an example of immediate needs will mean addressing deficiencies in specialist cancer nursing and strengthening the role of the NCCP; the development of comprehensive electronic patient records is seen as a medium-term issue; and the steering group has wisely decided to revisit its recommendations in 2021 to map out realistic goals for the latter part of the strategy’s life.

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Here is the vision set out in the 2006 national cancer strategy: "Ireland will have a system of cancer control which will reduce our cancer incidence, morbidity and mortality rates relative to other EU-15 countries by 2015. Irish people will know and practise health-promoting and cancer-preventing behaviours and will have increased awareness of and access to early cancer detection and screening. Ireland will have a network of equitably accessible state-of-the-art cancer treatment facilities."

Inevitably some of its goals have not been fully met. Despite the enormous progress achieved by Prof Tom Keane, the inaugural director of the NCCP in streamlining cancer treatments to eight national centres of excellence - there is still a need to complete the centralisation of cancer surgical services. And while progress has been made, internationally we remain behind those countries that are leading the way in cancer control.

One of the key elements in the latest strategy is a greater involvement of the public. A national cancer patient forum has had a central role and a series of public submissions have also informed the final document. An emphasis on cancer prevention initiatives and the development of psycho-social services in the 2017 strategy reflects public priorities. And the absolute unacceptability of cancer patients being readmitted through chaotic emergency departments is an important priority raised by patients.

Cancer survivors

Some 150,000 people in the Republic are cancer survivors. They and their families will appreciate the emphasis placed on their needs in the strategy. While the needs of individuals will vary greatly, a common aim is to live as full a life as possible after cancer treatment. The emphasis in the strategy on maximising the quality of life of individuals diagnosed with cancer for as long as they live includes a commitment to offer patients individualised treatment and summary care plans. Cancer survivors will also welcome a promise to carry out individualised ‘needs assessments’ which will help to ameliorate some of the financial and practical challenges they face.

One of the biggest challenges over the next ten years will be to ensure that the potential benefits of molecular cancer diagnostics and cancer genetics will be realised for all patients. This will require significant capital investment. And the development of more effective drugs and treatment modalities will inevitably mean an expensive leap in drug bills. Ring-fencing of cancer drug funding may be necessary in future health budgets if patients are not to lose out on proven treatments.

The 2017 National Cancer Strategy, which prioritises the cancer patient over the disease, is a welcome step forward.