Irish cancer survival could improve by up to ten per cent

Irish cancer survival could improve by up to ten per cent if we successfully implemented well-organised cancer  control systems, Dr. Susan O’Reilly, National Director of the HSE National Cancer Control Programme, told the June Dublin Mid Leinster HMI Regional Forum meeting in the Dublin Dental Hospital, Maureen Browne reports.

Irish cancer survival could improve by up to ten per cent if we successfully implemented well-organised cancer control systems, Dr. Susan O’Reilly, National Director of the HSE National Cancer Control Programme, told a Dublin Mid Leinster HMI Regional Forum meeting in the Dublin Dental Hospital in June.

Dr. Susan O’Reilly
Dr. Susan O’Reilly

She said that the number of invasive cancers in Ireland was projected to increase by 46 per cent between 2010 and 2020 and by 108 per cent between 2010 and 2030.

She said that critical success factors in cancer outcomes were population-based screening, early diagnosis/stage shift, multidisciplinary teams, high volume/expert centres and national standards/guidelines/protocols/policies/processes.

Other critical factors were doctors and specialist nurses, allied health professionals and the tools of the trade such as diagnostics, theatres, ambulatory/inpatient resources, LINACS and drugs.

Essential elements in implementing radical change were a well developed strategy, stakeholder “buy in,” political support, Department of Health and HSE support, access to resources, leadership, communications/respect, team building and a focus on implementation.

Between 2007and 2009, eight designated Cancer Centres had been established in four networks, all breast cancer surgical services were consolidated into eight centres, treatment of brain, lung, rectal, oesophageal and pancreatic cancers were centralised, a National Radiation Oncology Programme was planned, screening services were integrated into the NCCP and multidisciplinary treatment planning meetings were held for the majority of new patients.

The number of invasive cancers in Ireland was projected to increase by 46 per cent between 2010 and 2020 and by 108 per cent between 2010 and 2030.

Beaumont and the Mater Hospitals are the Cancer Centres for the HSE Dublin-North East Network, St. James’s and St. Vincent’s Hospitals are the Cancer Centres for Dublin –Mid Leinster, Cork University Hospital and Waterford Regional Hospital are the Cancer Centres for the HSE South Network  and UCG Galway (satellite: Letterkenny) and Limerick Regional Hospitals are the Cancer Centres for the HSE South.

Multidisciplinary Team Meetings to plan individual patient treatment were providing diagnostic expertise, surgeons with specialised cancer expertise and high volume practices, radiation and medical oncologists with sophisticated knowledge and experience, plus access to hi-tech therapy and a compassionate caring environment with supportive nurses, social workers and other health care professionals.

Between 2005 and 2011 the number of hospitals carrying out lung surgery had dropped from six to four, the number of hospitals carrying out breast surgery had been reduced from 32 to eight, the number carrying out rectal surgery was down from 30 to ten, the number carrying out prostate surgery was reduced from eight to seven and the number carrying out oesophageal surgery came down from 11 to four.

In 2009, breast cancer surgery had been centralised and GP referral guidelines and a standardised referral form introduced.

In 2012 Electronic GP referral via Healthlink, a National Lead Clinicians Network for Symptomatic Breast Disease and an inaugural Breast Audit, Quality and Risk Forum were introduced.

Developments in 2011 included the integration of electronic referral into all GP software systems, the production of GP guidelines and patient booklet for mastalgia, the establishment of a national Breast Tumour Group, a Technology review – Oncotype DX, a second Breast Audit Quality and Risk Forum and nursing education programmes.

This year, 42,000 new breast, lung and prostate patients were expected, and nationally the electronic referral was to be embedded in all ICGP accredited software systems.

In 2011, there was a total of 37,763 attendances at symptomatic breast disease clinics. Of these, 13,682 were urgent attendances (95 per cent of these were seen within two weeks) and 24,081were non urgent attendances.  There were 2,077 primary cancer diagnosed (5.5 per cent of total attendances)

In 2011, there were 1,944 attendances at the Rapid Access Lung Clinics and 733 primary cancers were diagnosed (38 per cent of the total attendances).  There were 2,466 attendances at the Rapid Access Prostate Clinics and 925 primary cancers were diagnosed (37.5 per cent of total attendances)

This year, 42,000 new breast, lung and prostate patients were expected, and nationally the electronic referral was to be embedded in all ICGP accredited software systems.  Over 80 per cent of GP practices were currently using this system and the target was for 20 per cent online referrals this year.

Dr. O’Reilly said Phase 1 of the development of a National Network of Radiation had been completed last year with the opening of new NCCP radiotherapy facilities in St. James’s and Beaumont sites and a 50 per cent increase in treatment capacity in Dublin. Phase 2 Plan was progressing and in November 2011, capital had been approved  for the next five years.

The 2012 targets included the NCCP Technology Review committee for oncology drugs and related molecular tests which was implemented in March 2012 and a national oncology drug budget.

National Tumour Groups had been initiated in 2011 for gastrointestinal, breast, genitourinary, lunch and gynaecology.

On the education and research side,  the culture of clinical research participation and innovation across professional disciplines and services, collaboration with professional colleges and universities to support continuous professional education and develop primary care skills in prevention, diagnosis care and follow up to facilitate safe, high quality care in the community all needs to be fostered.