The designation of Letterkenny hospital as a satellite centre for the Galway specialist cancer unit irked Sligo
THE CONTINUED full-scale campaign against the closure of the breast cancer unit at Sligo General Hospital has come as a surprise.
The indications until recently were that the consultant surgeon who runs the unit would eventually agree to participate in a more centralised service at University Hospital Galway, effectively depriving local campaigners of a key plank in their fight to retain the facility.
However, unlike his surgical colleagues in Castlebar and Letterkenny, Tim O'Hanrahan has stuck to his belief that the standard of breast cancer services in Sligo was as good as other specialist units and that it was unreasonable to ask women and their families to travel to Galway as part of the rationalisation of services by the National Cancer Control Programme (NCCP).
Other breast surgeons now routinely carry out some surgery in the specialist units as well as continuing to operate on women in their local hospital.
Crucially, they also attend the multidisciplinary meetings at which the diagnosis and treatment of women with breast cancer is decided - a key factor in international studies that show a 20 per cent reduction in death from the disease when patients are looked after by specialist units treating a minimum volume of patients.
Speaking to The Irish Times in 2007, Prof Tom Keane, the interim director of the NCCP, said the strategy, based on eight specialist cancer centres, was not for renegotiation. He was not available to the media yesterday.
It is clear from many reports that women have been exposed to an unacceptably wide variation in the standard of care provided by different hospitals in the State. With a death rate some 15 per cent higher than the EU average, something had to be done.
Although many units offered patients good quality care in line with the O'Higgins guidelines on the management of symptomatic breast disease - based on multidisciplinary care and triple assessment - others did not. Multidisciplinary team working and triple assessment are key elements in bringing down the death rate from breast cancer. The triple assessment of a breast lump in a dedicated clinic means a woman will undergo radiology (usually a mammogram), examination by a specialist breast surgeon and a biopsy of the lump, which will be examined by a pathologist specially trained in breast pathology. Clinics offering triple assessment aim to carry out all elements at a single visit.
A key factor in good cancer care is to have all health professionals involved in a woman's care located in one place, enabling multidisciplinary teamwork to take place. At the centre of this concept is a weekly conference of all staff at which the diagnosis and future treatment of the patient are discussed.
Some of the unhappiness in Sligo stems from the designation of Letterkenny hospital as a satellite centre for the Galway specialist unit. This was done on an exceptional basis in recognition of potential five-hour journeys to Galway for women living in parts of Donegal.
But if this concession was made countrywide, each specialist centre would have at least one satellite attached, potentially diluting the gains in survival achieved by centralising treatment. With patients from west Kerry travelling to Cork and women from the northeast being assessed in Dublin, making a political exception for Sligo was always an unlikely outcome.