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Cancer care - a damning indictment
[ by Niall Hunter, Editor www.irishhealth.com]
Roddy Carter attended the emergency department of Dublin's St Vincent's Hospital a number of months ago in severe pain.
He was diagnosed with advanced bowel cancer and was operated at St Vincent's within three days of attending A&E.
So, a good news story perhaps of prompt diagnosis and action by a major hospital? Well, yes and no. For Roddy had already been on the waiting list at another hospital, Tallaght, for a colonoscopy to check for bowel cancer for 12 months.
Addressing the Oireachtas Health Committee this week, Mr Carter said if he had not become so frustrated at waiting for his test and gone to St Vincent's, he would probably still be waiting for a bowel test at Tallaght.
He says his story is not an isolated one, and it certainly has echoes of the case of Susie Long, who died in October 2007. She had had to wait seven months for a colonoscopy, and eventually died of bowel cancer. If she had gone privately, she could have been seen in a matter of days.
Mr Carter told the Oireachtas Committee that despite major improvements in cancer facilities and staffing in recent years, patients with potentially serious cancers are still not being diagnosed on time, due, he says, to a lack of urgency on the part of hospitals, and failure to extend opening times to clear waiting lists.
The Irish Cancer Society said yesterday there are currently 834 people waiting over three months for a colonoscopy to check for bowel cancer - 182 of these have been waiting more than six months.
This is an improvement on figures for bowel cancer testing rates announced by the Society last Summer, and some hospitals now have no waiting lists, but the figures are still not much to write home about.
For despite the tragic case of Susie Long, the promises of improved facilities, improved staffing, improved services, designated "centres of excellence", we still have a two-tier hospital system when it comes to treating cancer.
Early detection is vital in bowel cancer and experts believe you cannot wait more than six weeks for a bowel cancer test after being referred to hospital by your GP.
Around half of those diagnosed with colorectal cancer in Ireland are diagnosed at relatively late stages of the disease when survival rates are fairly poor. We have the highest rates of bowel cancer in Western Europe.
The reduction in waiting times for colonoscopies has only come about through patients being referred on to the National Treatment Purchase Fund, so that they can be tested in private hospitals.
Many public hospitals it appears, cannot cope with the current demands for cancer testing.
But an often vital test can be done quickly in the private sector if you have insurance or if you are referred on privately, at great expense to the taxpayer, through the NTPF.
It is a severe indictment of our public health system if it cannot provide basic testing services for those with suspected cancer.
Even if you want to get treated for cancer there can be delays. irishhealth.com recently reported on a case where a man had to wait 14 months to begin radiotherapy treatment in a public hospital for his prostate cancer.
It was only after his sister highlighted his case in the media that something was done.
And these are not just isolated cases.
A study published in late 2006 by the Cancer Society and the Irish College of GPs stressed the need for equity of access for all patients regardless of insurance status to cancer care, and the authors of the report stressed that the bias in the system towards private patients getting tested earlier for suspected cancer must end.
GPs surveyed in the study complained of long waiting lists for investigation and referral for cancer tests for their patients who could not afford to go privately.
Shortly after this study was published, the Susie Long case was highlighted in the media and more recently, the Cancer Society has highlighted long waiting lists for public patients awaiting bowel cancer tests.
As with the breast cancer testing and other scandals, it is only when some brave person 'whistle-blows' that the health authorities spring into action.
The current reorganisation of major cancer care into eight designated centres around the country only happened after "whistle-blowers" highlighted errors in testing in a number of cases. Prior to this, a plan to revamp cancer care had been gathering dust on a HSE shelf for a number of years.
Cancer is far too serious a condition to be left to the lottery of whether or not you can access private care.
Every effort must be made to ensure that all patients with cancer or suspected cancer are given equal access to testing and care.
Health Minister Mary Harney has promised that under the new consultant contract, all patients, public and private will have equal access to diagnostic testing in public hospitals. This is very welcome and long overdue, and hopefully it will be put in place.
However, as with many policy decisions of this Government, just when it seems to be taking a step forward, it takes two steps back on cancer care.
In recent months we have had worrying news on cancer prevention and treatment. First we had the cancellation of the cervical cancer vaccine programme late last year.
More recently we have had doubts about the speed at which the designated cancer centres will meet quality standards, and we also have heard that BreastCheck's final roll-out in the West has been delayed and that there are doubts over a planned bowel cancer screening programme.
It makes one wonder how serious the Government is about improving cancer services.
|brandy Posted: 06/05/2009 16:36|
Don't know why I missed this.
I Recently had a colonoscopy. Can not say enough about the wonderful people in the hospital throughout this experience....they were brilliant!
What I will say....since I haven't been able to communicate it to the admin staff...is the following; before attending the clinic....everyone is given/posted guidelines+preparation material for the procedure....which is 'fairly' comprehensive.
The one thing that was NOT on my 'list' of things to do before procedure....was to make sure I had not taken aspirin the day before!
I went through the 24 hr prep (diet+digesting the recommended picolax)....ordered the taxi (to and fro... advised) .....only to discover that when I was in the theatre....at the last minute....the doctor said...because I had taken 300mg of aspirin the day before...if he 'discovered' anything....he would not be able to take a biopsy....due to possible excess 'bleeding' !
As it happened...he did discover something....so now I have to wait at least 6 weeks for the next/repeat procedure....and further for the results of any biopsy!
Surely, surely...it's not beyond the wit of those in admin to 'scribble' an additional couple of words on a direction....to ensure you won't take an aspirin based product etc?
Just thought I'd mention this....in case any one out there goes through the same thing.
Does'nt it seem strange that with such a prevalence of these cancers...that absolutely all considerations are not put in place.
Hope I'm the only one worrying....but I suspect Im not. Thank you.
|Anonymous Posted: 08/05/2009 09:47|
Hello bandy, I hope whatever is discovered turns out to be minor but you mde a very good point. I remember 20 years ago, my dentist telling me I would need an extraction and when he as schedulign the appointment he advised me not to take aspirin for 24 hours beforehand. Now if he could manage to do that inthe 80'S why can medical admin staff not advise of this 20 years later for colonoscopies.
|gg Posted: 08/05/2009 23:27|
what are the early signs of bowel cacer?
|blacky Posted: 09/05/2009 23:17|
does anyone know of an insurance company that offers life insurance to someone who has had cancer? been turned down by so many, dont think it is fair that they will not insure someone like me just because we have had a serious illness in the past doesnt mean we will have it again in the future!!!!
|MM Posted: 12/05/2009 17:50|
Know someone who had a strong family history of Bowel cancer and went for regular check ups...then developed stomach symptoms....had gastroscopy done to reveal Helicobacter pylori....had barium enema...negative...colonoscopy ...Negative....six months later got a blocked bowel from tumour that had grown so fast???? as to obstruct....When Dr was questioned said the tumour must have been missed as it was on the outside of the bowel..RUBBISH. It is not the health service alone that is dysfunctional, it is the appaling medics who are working all day and night and the following day without sleep. They are more dangerous to your health than a drunk driver and no one can COP ON.
|Renovatio Posted: 14/05/2009 11:25|
Currently battling to find out what is wrong with me. Potentially cancer. Fighting for recognition on the public system like everyone else. Had barium follow through, abdominal UC, Spinal and abdominal non-contrast MRI (apart from the 1st all at my own cash expense), all negative. Currently under investigation by tallaght hospital for what may be pancreatic cancer, if you could call being told to come back in 3 months after the blood tests are done an investigation. They say they are very busy so it can't be sooner. Apparently one of the blood tests for pancreatic cancer markers is only conducted on the public system every 8 weeks in a batch. Considering that 90% of pancreatic cancer sufferers die within 1 year of diagnosis and that early detection of a tumour is the ONLY hope for survival it stands that public patients have virtually no hope of survival or even belated diagnosis to give them more time to get their affairs in order.
|Insider Posted: 14/05/2009 23:55|
As a doctor, I have two comments related to other posts:
1. Brandy, I understand your frustration. However, clerical or admin staff cannot empirically tell everyone to stop aspirin before a colonoscopy. Most people who are on aspirin have a histroy of, or are at significant risk for a heart attack or stroke, and the aspirin is an important preventative measure that should only be stopped if there is a definite medical need. The effects of aspirin can take up to 10 days to wear off, so usually it is stopped for at least 5 days before a biopsy. What if a patient was told to stop their aspirin in advance of the procedure, had a heart attack / stroke while off the aspirin, and when they ultimately got the colonoscopy, there was nothing there that needed a biopsy? They would have stopped the aspirin unnecessarily, but with serious health consequences. It is because of this risk that people are often not told to stop the aspirin until it is known for certain whether or not they will need a biopsy.
2. MM, you are clearly upset by your friend's experience, but you do not know all the medical facts of the case. Of course, neither do I. But I want to point out that the doctor may actually be telling the truth. Bowel blockages can happen from tumor growing outside of the bowel and pressing on the bowel from the outside. In such cases, a colonoscopy done a few months earlier would almost certainly have been normal, since the doctor only sees things that are growing inside of the bowel. Bowel blockages from tumors growing outside of the bowel often happen with advanced ovarian cancer, or with other advanced tumors that have spread within or to the abdominal cavity.
|Russel Posted: 15/05/2009 21:50|
Hi, you were one of the fortunate ones. There is people waiting 8 months for this test in parts of the midlands. They found a tumor on my lung exactly one year ago and still done nothing. They say its not cancerous at the moment but will most likely turn into cancer in the future, it's just frightning because my da died of lung cancer last year and my ma died of lung cancer three years ago. I;m just wondering are the waiting for me to die aswell, they way I look at it the tumor should not be there and I want it out, if I was living in America they would take it out when first spotted, I think we are twenty years behind in this cancer scene. I would love to hear some ones thoughts on this.
|Anonymous Posted: 18/05/2009 10:17|
Needless to say ussel I think they are behaving in an appaling maner - espcially considering your family history.
As for America, well I know that in the U.S. they would have removed it if you have yoiu had private insurance. If you were under a HMO - well it would depend on your HMO - NOT the doctor, which is a horible way to treat anyones health. Otherwise they would do it if you had the money to pay, that is the way healthcare (sick-care) works in the U.S. If you were poor - well, I wouldn't fancy your chances at all to be honest.
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