SECOND OPINION: On Thursday the Dáil will address concerns with the Government's plan for radiotherapy services. Jane Bailey highlights the issues Cancer Care Alliance hopes will be addressed
The Government has accepted the recommendations of the report on the Development of Radiation Oncology Services in Ireland, and its acknowledgement that a major programme is required to rapidly develop clinical radiotherapy services is widely welcomed. The shortfall of radiotherapy services is of such a magnitude that 16 per cent of Ireland's cancer patients receive radiotherapy while international figures show uptake should be 60 per cent. The report acknowledges that failure to deliver radiotherapy can result in a reduced chance for patient outcome and that there is an increasing need to integrate radiotherapy with other modalities of surgical and medical oncology.
The report concludes, however, that the further development of existing radiotherapy centres in Dublin, Cork and Galway will be targeted for the first phase of the programme up to 2014 and possibly 2020. In addition, the report recommends that the patient population residing outside Dublin, Cork and Galway will be "best served" for the foreseeable future by the development of additional treatment capacity at existing units.
The Cancer Care Alliance is concerned that despite identifying the "ideal cancer care facility" as a single site with a range of integrated cancer services providing best outcome, patients outside Dublin, Cork and Galway are to be denied multidisciplinary care in their regional cancer units and will have to leave their regional cancer centre for radiotherapy. It appears that equity of access to quality radiotherapy is not to be extended to cancer patients outside the three chosen regions.
Micheál Martin, the former Minister for Health, in accepting the centralised model of radiotherapy viewed proximity to a centre to be a benefit in terms of convenience, but said it would not be a deciding factor in providing services.
Mr Martin and the expert group have failed to understand that proximity to a regional radiotherapy service is not necessary for convenience but because many cancer patients are too unwell to travel long distances.
The debilitating side effects of radiotherapy as treatment accumulates have been ignored. Half of all patients who require radiotherapy require it for palliative care. In advanced cancers, palliative radiotherapy offers quick and durable relief from pain and other difficult symptoms.The vast majority of cancer patients who do not live in a region facilitated with radiotherapy are unable to access radiotherapy for pain relief in the terminal stages of cancer. Travelling is simply not an option so increased medication such as morphine is required which may not be as effective.
Consistently, statistics from the National Cancer Registry have shown that patients in areas not facilitated by radiotherapy are less likely to receive it.
The tunnel vision approach by the expert group and Government to consider that geography will not be a barrier to equal access and will be overcome by dedicated transport solutions is simply not a reality.
The report chose to ignore international evidence which recognises that radiotherapy services should be planned to minimise travelling times with a maximum journey of two hours being considered feasible. While the report acknowledges the international evidence that no one model of radiotherapy is universally applicable, it rejects smaller sized radiotherapy units and considers a four to six linear accelerator unit the minimum treatment centre for future radiotherapy treatment.
The report fails to meet the multidisciplinary cancer needs of patients outside Dublin, Cork and Galway and cannot provide equitable access for patients outside these regions. An alternative proposal has been put forward by Cancer Care Alliance and joint political parties which would enable "equal access for equal need".
That alternative proposal calls for development of radiotherapy facilities at regional cancer units in the South East, MWHB and NWHB.
But implementation can only be ensured by the provision of regional radiotherapy and regional multidisciplinary care. Any service model other than regional deployment of radiotherapy is grossly inhumane and undermines the aspirations to a quality driven service.
While regional radiotherapy services can be delivered at little cost to the Exchequer, but with huge advantage to cancer patients, the Government must look beyond the cost element and recognise its obligation to all families to provide equitable cancer care.
A Government that cannot provide best treatment and care for cancer patients where a survival rate of 43 per cent is relatively low in European terms, must ask, where are they going? The proposed radiotherapy programme will influence cancer care for a minimum period of 15 to 20 years and probably longer.
The national solution must therefore not only improve existing standards of care, but be configured in a way that provides maximum opportunity to address the treatment and palliative needs of all cancer patients in an equitable way.
Cancer Care Alliance acknowledges that cancer patients expect the provision of rapid access regionally to the highest quality multidisciplinary cancer care and this must become a central priority of any proposed model of new radiation oncology services.