Sir, - To date, I and other members of staff at Our Lady's Hospital for Sick Children, Crumlin, have refrained from public comment on the recent controversy over the organisation of childhood leukaemia services. However, the inaccurate statements in the letter from Ms Elizabeth Pearson Evans (March 11th) and earlier reports in your newspaper will undoubtedly have caused anxiety and distress to parents, siblings and the extended families of those children who have been treated for cancer in Crumlin or are now undergoing treatment there. If for no other reason but to address the concerns of those families, a response must now be made.
The statement that "ad hoc" treatment is delivered in Crumlin is most unfortunate and is clearly untrue. Treatment is based on proven international protocols and is highly successful. A commonly accepted method of establishing the efficacy of treatment is to measure five-year survival rates. The five-year survival of children treated at Crumlin for acute lymphoblastic leukaemia is excellent and is superior to published survival rates for children entered into British trials during the same period.
The recent statements in the newspapers about the entering of patients into treatment trials are also misleading. The decision to use German protocols was firmly based on the fact that published survival data was better than with British protocols. We in this country should feel no need to follow any specific international protocol, but rather the best one.
Ms Pearson Evans additionally states that an attempt is being made to "destroy" the service at The National Children's Hospital in Tallaght. This misrepresents the facts. Bearing in mind that the quality of cancer services for children must be of primary concern, the Minister decided to accept the recommendation of the National Cancer Forum that every child with cancer should be seen initially at Our Lady's Hospital but that subsequent treatment could then be delivered in the most appropriate local hospital. The Minister's decision in this regard is consistent with the published recommendations of several other expert groups, both in Ireland and abroad. Indeed, it should be noted that this practice of sharing the care of children between a central paediatric cancer unit and local hospitals has been successfully in place in Crumlin for many years.
The letter of March 11th also implies that the treatment of children with leukaemia by oncologists is inappropriate. However, in Britain childhood leukaemia is treated by both paediatric haematologists and paediatric oncologists. In the US and Europe, this treatment is provided almost exclusively by paediatric oncologists. The unit in Crumlin is run by three full-time paediatricians employed for the care of children with oncological and haematological problems. Dr Anne O'Meara and Dr Fin Breathnach are paediatricians fully trained in paediatric oncology. Dr Aengus O'Marcaigh is a paediatrician trained in paediatric haematology. Dr O'Marcaigh is the only fulltime paediatric haematologist in this country. This unit treats up to 80 per cent of the 130 children diagnosed with cancer in Ireland each year, including the majority of those with leukaemia. This has been the case for many years.
Furthermore, this unit does not operate in isolation. Paediatric cancer services are vitally dependent on input into patient care from a broad range of other specialists. The three consultants in the haematology/oncology unit receive support from such services as paediatric surgery, cardiology, infectious disease, neurology, respiratory medicine, pathology, radiology and gastroenterology/ hepatology. A paediatric intensive care unit is another vital component of any comprehensive cancer service and the largest such unit is in Crumlin hospital. In addition, bone marrow transplantation is an important element in the treatment of children with leukaemia. A successful, purpose built, internationally accredited bone marrow transplant unit has been in operation at Our Lady's Hospital for many years.
Ms Pearson Evans also makes the point that the EU's recommendation of one unit per five million of the population is not applicable to Ireland because the population is below five million and too dispersed. In my opinion, he existence of a smaller, dispersed population actually strengthens the case for the co-ordination of treatment at one centre and for collaboration between those involved in the provision of service. Her statement cannot be used to justify the presence of two paediatric cancer units operating independently of each other and less than four miles apart.
Collaboration and reorganisation in a way consistent with the decision taken is the best way forward. The chief medical officer of the Department of Health and Children has been asked to convene a meeting of the clinicians directly providing the service. Hopefully, this meeting will not be long delayed.
I trust that this response will have provided some measure of reassurance to those parents and families who have been referred to Our Lady's Hospital, Crumlin. Finally, if any parent of a child with cancer wishes to meet the staff of the unit in Crumlin to discuss any concerns they may have, I will be happy to endeavour to facilitate such a meeting. -Yours, etc., Dr Michael McDermott, MB, MRCPI, MRCPath., Chairman of Pathology, and Laboratory Medicine, Our Lady's Hospital for Sick Children,
Crumlin, Dublin.