The Government is being called upon to rethink its centralisation policy. Martin Wall reports.
Jane Bailey tells of a woman she knew, in severe pain as her cancer progressed towards its terminal stage.
Radiotherapy, as a palliative treatment, would have eased her distress. However, the woman had secondary tumours in her spine and bones which made unthinkable the prospect of spending several hours on a regular basis in an ambulance travelling to Dublin. In the end, Bailey says, the woman died in "unnecessary pain".
The patients who require radiotherapy for palliative means, argue Bailey and fellow campaigners, are the people who the medical establishment in the form of the Hollywood expert group and now the National Cancer Forum, the Government's advisory body on cancer care, have abandoned in their drive towards centralisation of services.
Ms Bailey, a midwife at Waterford Regional Hospital (WRH), was to the forefront in the high-profile campaign to have public radiotherapy services established in the south east. Ultimately this battle was lost and the Government adopted the recommendations of the Hollywood expert group on radiotherapy which proposed that services be concentrated in four large centres in Dublin, Cork and Galway.
The Government's fall-back position was that the south east, mid-west and other areas could be considered at a later date, particularly if the population increase. It indicated that in the interim it would look favourably at purchasing services from a number of small private-sector radiotherapy centres that were being planned for these areas.
However, now even that concept is under threat with the National Cancer Forum expressing concern that such a proliferation of small private units could undermine the overall blueprint for centralised radiotherapy.
Ms Bailey and her campaigners in the Cancer Care Alliance (CCA) are gearing up for a new battle over recommendations for the future development of cancer services overall which will be contained in the long-awaited new Cancer Strategy to be completed next month (see panel).
Over the coming weeks cancer care will move towards the forefront on the medico-political agenda with the Tánaiste and Minister for Health, Ms Harney due to meet the CCA, including a number of leading clinicians, next week. The Minister is also scheduled to go before the Oireachtas Health Committee early next month to outline her own ideas for developments in cancer and other areas. Finally, at the end of February it is expected that the much-leaked strategy document will be officially published.
All the expert groups acknowledge the best outcome for patients with cancer is reached when they are treated as part of a multidisciplinary approach involving medical oncologists who administer chemotherapy, radiation oncologists who deliver radiotherapy, and surgeons.
However, the CCA argue that under the strategy proposals - which would see common cancers such as breast, lung, bowel and prostate treated in regional centres - patients with these conditions would not have access to radiotherapy facilities on site. The strategy will argue radiotherapy should be reserved for a small number of supra-regional centres which will deal with more complex cancers.
Ms Bailey says patients in Dublin, Cork and Galway with the same conditions were likely to be treated in supra-regional centres with multidisciplinary facilities including radiotherapy and therefore have the prospect of better outcomes. "We say geography is critical to the provision of equitable care for patients. We will not accept a rationalisation of best outcomes for patients in the regions."
The arguments behind the establishment of large radiotherapy facilities with several linear accelerators (the machines used in the delivery of radiation treatment) is flawed, Ms Bailey adds. She maintains there is no international evidence to suggest the outcome for patients treated in units with one or two linear accelerators is any worse than that for patients who went to larger centres.
The argument about dying patients being denied access to radiotherapy for palliative care will also be to the forefront in the campaign against the Cancer Strategy proposals in the weeks ahead.
"The Hollywood report itself acknowledges the relief that can be provided by radiotherapy to patients with terminal cancer. However, the centralised model does not, in reality, allow for such patients in the region to have access to these services.
"Patients with secondary cancers in the spine and bones will not be able to spend several hours in an ambulance, no matter how comfortable they are. In fact, they will not be selected to travel by their doctors. Patients will die in a lot more pain than necessary or spend their final days under strong sedation to control the pain. They are the patients who the Hollywood Report and the National Cancer Forum have abandoned," Ms Bailey says.
Doctors in the Cancer Care Alliance (CCA) also argue that the Government will have to invest heavily in hospital facilities before the proposals of the new strategy can be realised.
Consultant medical oncologist to WRH, Dr Paula Calvert, who will be at the meeting with the Tánaiste next week, says that at the regional centre in the south east up to 25 day patients receiving chemotherapy or blood transfusions are seen in a re-configured six-bed bay. The unit also has access to three adjacent single rooms but space is at a premium.
Cancer services have been developed significantly in the south east in recent years as part of the Government's investment programme in oncology. There are now three consultant medical oncologists and three consultant haematologists. However, there are only six oncology and six haematology inpatient beds.
Dr Calvert and her colleagues have campaigned for several years for a new 30-bed purpose-built oncology unit. But in recent years there always have been other priorities for investment from a strained health budget.
When it meets the Tánaiste next week, the CCA will argue that if equitable access to treatment is to be provided, the Government will have to loosen the purse strings for new facilities and re-think the strategy of centralisation which it maintains will seriously disadvantage people outside of the main urban areas.
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