The target of reducing the death rate from cancer in the under-65s by 15 per cent in 10 years has been achieved well within time, writes Martin Wall
Since the first national cancer strategy in 1996, services for patients with the condition have come a long way, albeit from a low base.
Tens of millions of euro have been invested and dozens of additional consultants appointed. As a result, the target of reducing the death rate from cancer in the under-65s by 15 per cent within 10 years has been achieved with considerable time to spare.
The new cancer strategy document warns there is still much to be achieved. With the exception of paediatric oncology the incidence of and survival from most forms of cancer in Ireland is below the EU average. And even within Ireland, survival rates vary between regions.
"There is inequity in the availability, access to and performance of cancer services throughout the country," the document states. It maintains that existing care is fragmented, with too many hospitals and too many consultants involved in treatment.
It says a comprehensive cancer strategy - covering health promotion and prevention, as well as diagnosis and management - is vital given that the numbers with the condition are expected to grow significantly in the years ahead as the population increases and ages.
Central to the new plan is the establishment of four cancer networks around the country. Each network would comprise integrated GP care, hospital care, palliative care and psychological and support services.
The report says there is considerable scope to develop a much greater role for primary care in dealing with cancer. It suggests that primary-care services could include health promotion, early detection, and palliative care.
Even before publication, the strategy has faced criticism over its proposals for hospitals. Its recommendation that care should be provided in eight centres catering for a minimum of 500,000 people would inevitably threaten existing services, particularly surgery, in some smaller units.
Specifically the report calls for a review of the 14 hospitals currently dealing with symptomatic breast cancer. It suggests there should be two or possibly three cancer centres in a network.
It maintains that all patients should have their diagnosis established and treatment planned by specialist multi-disciplinary teams.
The strategy also places heavy emphasis on screening and on health promotion. It recommends the extension of the Breastcheck service to women aged up to 69 (at present 64 is the upper limit) and the introduction of a new screening service for colorectal cancer - the second most common cancer in Ireland.
The controversial proposal for a licensing system - for which case volume would be considered - could have implications for cancer services in some existing or planned private hospitals.