The practice by Irish hospitals of routinely recalling all patients who have had cancer for check-ups for years after they have been successfully treated for the disease should end, the State's new director of cancer control, Prof Tom Keane, has indicated.
He said the practice had been shown to be unnecessary and it did not improve outcomes. Patients, in most cases, could instead be followed up by their family doctor or be discharged altogether after a period.
If fewer patients were recalled by hospitals for check-ups, the waiting time for new patients to be seen could be reduced, he added. Prof Keane has in the past week begun consultations with cancer specialists on this issue.
He told The Irish Times yesterday there was no need for endless hospital check-ups for patients who have had most of the major cancers such as prostate, lung, breast and bowel cancer. "There are some cancers you have to follow - it's a minority," he said. He added that the constant hospital check-ups were unnecessarily worrying for patients themselves. "Some of them don't sleep for a week before their appointment and there is nothing wrong with them. These people are at very low risk of recurrence and the system just does this to them," he said.
If this practice continued after cancer care was centralised into eight centres of excellence, which is the plan over the next two years, patients would have to travel farther for hospital check-ups, he added
He also told a recent Oireachtas health committee meeting that practices that do not contribute to better cancer outcomes, but that are embedded in the system, "will have to change", adding that many of them were physician driven.
"There is a widespread belief - it is also a practice - that patients with cancer need to be followed by their oncologists. Patients, even though they have been cured, are sometimes followed for up to 20 years. Under the current system, patients return to see either their original consultant or a registrar and, even though the evidence indicates that they have been cured, they are given an appointment to come back again a year later.
"In British Columbia, patients are brought back for follow-up interventions at cancer centres only if there is demonstrable evidence that such interventions are likely to improve their chances of survival.
"There is significant literature to the effect that routine follow-ups in respect of cancer patients . . . represent money poorly spent and that they do not produce better cancer outcomes." Some clinics, he said, were seeing 40 cancer patients a day of which only four were new ones.
Dr James Reilly, Fine Gael's health spokesman, agreed with Prof Keane. The routine recall of former cancer patients for hospital check-ups was unnecessary, inconvenient for patients and excluded the GP from the care of the patient that in these cases was the most appropriate, he said.