One of the most important and far-reaching policies to improve the health of Irish people in recent times was the 2007 decision to centralise cancer services. Under the direction of Prof Tom Keane, the National Cancer Control Programme set about addressing fundamental geographic and other inequalities in the treatment options available to cancer patients.
A new report by the National Cancer Registry Ireland (NCRI) is the first to comprehensively examine the "before and after" effect of moving cancer treatment to eight centres, each with a particular cancer type expertise.
The report shows the aim of optimising treatment and improving survival outcomes has largely been achieved. Patients first treated or diagnosed in one of the eight designated cancer centres had higher survival rates overall than those seen in other public hospitals. Notably, survival was over twice as high for people with lung, oesophageal and pancreatic cancers.
The significant progress made on cancer in the past decade suggests that a sustained focus on a problem can achieve results
However, survival rates for certain types of cancer are better if patients are attending private hospitals, the report finds. For rectal, breast and prostate cancers, survival of patients being treated at private hospitals “was on average significantly better”, the analysis shows. But for cases of stomach cancer, survival of patients in private hospitals “averaged significantly poorer” than in the eight designated cancer centres at publicly funded hospitals. This disparity of outcomes needs further analysis.
Leadership and expertise
While some private hospitals are co-located with the eight cancer centres and may share leadership and expertise, this is not always the case. The finding may also reflect a better background health among cancer patients who can afford private healthcare.
An increase in the proportion of patients treated in private hospitals was also seen over time for most cancers. The extent to which centralisation may have occurred among private hospitals must now be looked at. While this first analysis of the effects of centralisation of cancer services is welcome, it requires careful interpretation. The NCRI must undertake further work to fully explore its findings.
Far too many people continue to lose their lives to cancer. Yesterday, to mark World Cancer Day, the Irish Cancer Society launched a lung cancer action plan – recognition of the fact that lung cancer is a leading cause of cancer deaths, with over 1,800 people dying from it every year. That underlines the scale of the challenge.
Yet the significant progress made on cancer in the past decade suggests that a sustained focus on a problem can achieve results. In these turbulent times for our health system, it’s worth looking at the National Cancer Control Programme as a model for improvement in other areas.