The Irish Timesasked Prof Keane to consider two case histories and to outline the kind of experience every patient should expect in a revamped cancer service.
A 42-year-old woman living some distance from a cancer centre in a rural area presents to her GP with a breast lump and is referred to a specialist breast cancer centre. How does her journey progress from here?
Tom Keane:I would like her to get immediate access to a specialist breast clinic. I would like her to have access to transport if she needs it. When she gets to the clinic I would hope that the various tests she requires could be scheduled together on the same day and that she would see the appropriate specialists required to manage her problem. She will have a mammogram, which will be read by a radiologist with expertise in mammography. Should she have cancer, her management will be discussed by the entire team - medical and radiation oncologists, surgeons, breast-care nurses - at a multidisciplinary case conference.
I would like her to be given an immediate appointment for surgery. I would want her seen within two weeks of referral. I would expect her to be admitted for surgery within two to three weeks maximum. The woman should know from the beginning what her journey looks like, how long it's going to take, what the order of events are going to be.
A 59-year-old man who lives in Dublin is told by his GP that a test for prostate cancer (PSA blood level) is significantly elevated. He has no symptoms and his prostate gland is not enlarged. How will he be managed initially? Following investigation he is found to have a malignancy that is confined to the prostate gland and has not spread. Can you outline his patient journey?
Tom Keane: He will be sent to a urologist and possibly a multidisciplinary clinic, where he will have a transrectal ultrasound and biopsies taken. The biopsies will be reviewed by a trained pathologist in prostate cancer and then we will know whether he has cancer or not . . .
So now he has cancer. He has two options for treatment in this case, either surgery or radiation therapy - and there is a possibility of hormonal treatment. Ideally he should see both of these individuals [a surgeon and a radiologist oncologist] on the same visit and hear what the recommendations are - the options are very similar in this case in terms of outcome, so he should have the freedom to choose which way he wants to go. I think his treatment should be scheduled within four weeks [of diagnosis]. [In terms of follow-up] he should have six monthly PSA checks and if he has a PSA bounce [a sudden increase in PSA blood levels] he should come back into the system. [In British Columbia], patients with a history of cancer get preferential treatment . . . They have a card that says they are a cancer patient. They get a rapid re-entry into the cancer system.