Terminally ill cancer patients ‘forced into overcrowded EDs’ to access care

Terminally ill cancer patients are being forced to wait long periods in hospital emergency departments in order to access urgently-needed care, an Oireachtas committee has heard.

Often, the only way for seriously ill cancer patients, including those with terminal diagnoses, to “get into the system” is to go an emergency department (ED) at weekends, according to the Irish Cancer Society.

Chief executive Averil Power described the lack of alternative pathways for cancer patients to access care as “intolerable”. “It is terrifying to think you have to go through an overcrowded ED to get access to care,” she told the Oireachtas health committee on Wednesday.

Prof Risteárd Ó Laoide, national director of the HSE National Cancer Control Programme, said an acute oncology nursing programme has been implemented, through which experienced cancer nurses assess cancer patients requiring acute care, so that attendance by cancer patients at EDs is minimised.

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Ms Power told the committee cancer services used to be the “poster child” of the health service and, pre-Covid, Ireland was closing the gap on other countries. “Now we are worried that not only has progress stalled, but we may be going backward.”

[ Varadkar to seek CMO’s advice over number of excess deaths reported in recent weeks ]

Social Democrat TD Róisín Shortall said it was disappointing to see “so much slippage in what used to be jewel in the crown” of the health service.

There are over 200,000 people on radiology waiting lists, Ms Power said, and one in four people sent to rapid access clinics are waiting longer than the HSE target. In the case of surgical treatment, only seven in 10 patients were able to get care within the timeframe set out in the National Cancer Strategy. Across all cancers, none met the target of 90 per cent of patients seen within the recommended timeframe.

There has never been a greater need to focus on cancer services, she said, but proper planning is impossible without proper data being available.

Survival rate

Opportunities to detect cancer early are being missed and patients and their families are “paying the price,” Ms Power said. The impact is being felt the greatest by those on lower incomes who cannot afford to skip the public queue by paying for tests privately.

“Our central concern is that, in Ireland today, people are not being given the best chance of surviving cancer and having a good quality of life. The earlier cancer is caught, the easier it is to treat and the greater the person’s chances are of surviving the disease.”

The five-year survival rate for colorectal cancer is 95 per cent if diagnosed at stage I but falls to 10 per cent at stage IV, Ms Power pointed out, while for breast cancer the survival rate falls from 94 per cent to 19 per cent when diagnosed late.

Prof Ó Laoide acknowledged cancer services are facing considerable challenges. There remains an ongoing impact from the Covid pandemic, the extent of which will not be fully understood for a number of years.

Up to 11 per cent fewer cancers were diagnosed in 2020, the year the pandemic started. “We do not yet have clear data on the impact on staging of cancer, but there are anecdotal reports of later stage presentations,” he said. “Another key challenge facing the cancer service is the recruitment and retention of staff, across almost all disciplines. This is a major challenge to sustained provision of services.

“While these challenges are common to many health systems around the world, any impact on individuals in Ireland facing cancer is regrettable. Cancer service staff around the country are working to minimise those impacts.”

The five-year survival for people diagnosed with cancer in Ireland averaged 65 per cent for patients diagnosed between 2014 and 2018, a substantial improvement from 42 per cent twenty years previously, he pointed out.

Prof Ó Laoide expressed support for measures to ban smoking outright over time.

Asked about New Zealand’s decision to prevent tobacco being sold to anyone born after 2009, and to increase the threshold age over time, he said this would be “helpful” in reducing cancer deaths.

He described as “really concerning” a finding that the most deprived people are almost 30 per cent more likely to die from cancer, compared to the least deprived.