Cancer care needs the funds to be beacon of hope

Cancer services in Ireland have made great progress — but there is much more still to do,

BOLD, brave decisions are often the start of something revolutionary. This has certainly been the case for cancer care in Ireland.

Thanks to the determination, vision and leadership of politicians, the medical and research community and civil servants, the outlook for people with cancer has changed dramatically since 1996. This is when Ireland got its first National Cancer Strategy. At that time, only four in 10 people survived the disease.

There was no gloss or shine to the plan but it didn’t need it. Clever graphics and stock images would have detracted from its focus on two simple but powerful goals. The first was to increase the number of cancer survivors. The second was to give cancer patients “the most effective care and treatment and that their quality of life is enhanced to the greatest extent possible”.

In 2006, a second cancer strategy was published. This time, a key goal was the centralisation of cancer treatment, particularly surgery, into designated centres focused on specific cancers. Patients would benefit from being treated by medics with more experience and expertise in their particular cancer. Despite political opposition, the then health minister held firm, certain that the decision was the right one. A report just published by the National Cancer Registry of Ireland (NCRI) has shown just that. We now have 173,000 cancer survivors in Ireland, many of whom would not be with their families today if it were not for centralised cancer services. It is the clear success of the brave approach taken in delivering the first two Cancer Strategies that makes the lack of progress on our third Cancer Strategy so disappointing.

Last Monday, we saw the Department of Health’s Implementation Report. It paints an underwhelming picture. Nineteen months after its publication, much of the progress that was promised has not happened. This is not down to the hard work being done by doctors, nurses and cancer researchers. It is evidence of the strategy sliding down the list of political priorities by not being given the funding it needs.

At the Irish Cancer Society, we have been monitoring progress. When the strategy was published, we welcomed it. We said key commitments like reducing waiting times would significantly improve patients’ experience. But we also said it needed to be properly resourced. The health minister’s foreword to the strategy ends with ‘‘now it’s all about implementation’’. Unfortunately, that remains the case. The Department of Health had seven targets to meet between July 2017 and December 2018. It has met only one.

One of the targets that hasn’t been achieved relates to how quickly someone should get a cancer test. If a doctor feels someone may have breast, prostate or lung cancer, the patient is supposed to be tested at a Rapid Access Clinic within a specific time. The lack of progress by Government in this area means some people with a suspected cancer are not being diagnosed as quickly as the strategy says they should.

We understand how this affects patients. Delays for cancer tests can cause significant additional stress when they are living with worrying symptoms. Imagine if this delay was the difference between being able to benefit from a certain type of treatment or not. This is the reality for people who are being denied timely access to cancer tests.

Progress on other targets is disappointing too. For instance, only three in 100 cancer patients are currently on a clinical trial. This means nothing has changed since 2017, despite a commitment to double this target by next year.

Being on a clinical trial gives patients early access to medicines that could extend or save their lives. It is critical that more effort is made in this area. Patients tell us that clinical trials give them hope and that if they could buy more time, they would spend it with the people they love. They want to be the one wiping sticky faces, the one clapping loudly at graduations, the one who is phoned for advice when the baby is sick. Clinical trials give us all hope for a cure.

Catching cancer early greatly improves the chance of successful treatment. That’s why our screening programmes are so important. Bowel Screen is our only screening programme for men and women. But too few people who are eligible for the simple at-home test are using it. That is why the Cancer Strategy committed to increasing those numbers by the end of last year. Sadly, this target was not met.

The Irish Cancer Society strongly believes the strategy can be revived with political momentum behind it. However, the HSE’s 2019 National Services Plan, states “the National Cancer Control Programme allocation for 2019 will not enable the service to match referral demands in areas such as radiotherapy, rapid access cancer clinics and diagnostics”. This is a complicated way of acknowledging that though the budget for the NCCP increased in 2019, more people will need to use cancer services than the system can cope with. The reason it cannot cope? Not enough money is being provided by Government.

We need to redouble our efforts to deliver a world class cancer service.

Some good work is underway. The Implementation Report highlights decreases in smoking rates; increases in funding for the National Cancer Registry of Ireland; and a renewed focus on the psychological needs of patients and survivors. We also warmly welcome the recent appointments of a Clinical Lead of Psycho Oncology and a Clinical Lead of Cancer Nursing. To achieve the ambition of the National Cancer Strategy, resources must be provided now. Complacency and underfunding will only lead to stagnation and slippage. We will not stand by and watch this happen.

The Irish Cancer Society is pulling every lever to make cancer care better so the patients of today, and those of tomorrow, benefit from the best cancer care. We want cancer services in Ireland to be a shining beacon of hope not only for the health service here, but for the rest of the world. Our cancer patients deserve that.

‘We need to redouble our efforts to build a world-class cancer service’