Powder keg of cancer delays
Charities call for clear plans to tackle feared log jam of diagnoses as concerns mount over patients at risk of survival and the HSE plays catch-up with cases delayed by Covid
CHARITIES have called for clear plans to tackle delayed cancer diagnosis amid growing concerns for patients with ‘low chances of survival’ as the Health Service Executive (HSE) plays ‘catch-up’ as it emerges from the pandemic.
Worrying figures emerged this weekend as it was confirmed the national screening service reached less than half of its target numbers in 2020.
And according to the HSE, referrals from GPs to cancer clinics are now at ‘extraordinary’ levels.
In 2020, BreastCheck only achieved 30% of its target with 56,270 women screened.
CervicalCheck screened 143,028 women, or 56% of its target, and BowelScreen saw 40% of its target, 50,000 patients. Overall just 44% of the screening services’ targets were met for 2020.
HSE Chief Operations Officer Anne O’Connor said cancer services across the board were now seeing a huge increase in referrals when compared with preCovid data.
There were 5,608 GP referrals for cancer services in March this year compared with 2,294 in March 2020. The number of 2021 referrals also far exceeds the 3,575 referrals in March 2019.
Ms O’Connor said diagnostic services such as colonoscopies were still not operating at ‘normal levels’, which was leading to an increased backlog.
It is also likely there are patients who didn’t present last year to their GP with concerns who are now coming forward, leading to increased demand.
This surge is also reflected in patient attendance at rapid access cancer clinics.
In March there were 5,252 attendances at rapid access clinics for those suffering from breast, lung or prostate cancer which need immediate attention. This compared with 2,714 in March 2020 and 4,356 in March 2019.
Last year 44,000 people attended rapid access clinics for breast, lung or prostate cancers, a 22% decrease on the 2019 attendance of 50,249.
Health Minister Stephen Donnelly confirmed a 22% decrease was also recorded in the number of patients receiving chemotherapy and a 10% decrease in the number of patients receiving radiology.
Minister Donnelly said €12m in funding would address backlogs, support virtual clinics, and increase capacity with a view to restoring cancer services this year to 95% of 2019 levels.
Jennifer Cimmerman, spokeswoman for the Marie Keating Foundation, which supports cancer patients, said the charity was concerned we would see an increase in delayed cancer diagnoses as a result of paused services.
She told the Irish Mail on Sunday: ‘We do have concerns that we could see a rise in the numbers of cancer diagnoses later and that this will have a negative impact on patients both in terms of treatment plans and outcomes.
‘The HSE announced that full cancer services would be resumed in Q4 this year subject to the vaccine rollout progressing well. Given that this appears to be the case with two million vaccines now administered, we fully expect this to be realised but would welcome an update in this regard and any clarification from them on what the plan is to deal with this expected surge, and how they will ensure that patients coming forward with delayed diagnosis or more advanced disease will be seen and treated without delay.’
Irish Cancer Society Director of Advocacy Rachel Morrogh told the MoS there was a noticeable ‘catch-up phenomenon’ occurring across cancer services and echoed concerns that ‘later-stage cancers will mean fewer treatment options and lower chances for survival for some people’.
Ms Morrogh said: ‘Once people are referred on for tests after going to their GP with symptoms of cancer, the HSE must ensure that everyone is given swift access to all follow-up tests and treatment needed.’
One GP, Dr Illona Duffy, confirmed there had been a considerable increase in cancer referrals from her clinic in Monaghan compared with last year.
Dr Duffy told the MoS: ‘Definitely we’re seeing more pathology we’re trying to screen what we’re seeing because there’s such demand of people wanting to be seen and getting appointments and you’re trying to do a catch-up, you’re trying to see your elderly patients because it’s not just cancer, it’s simple stuff like chronic renal failure, which is probably one of the big killers in Ireland, people with high blood pressure that’s uncontrolled [and] damages their kidneys.’ Dr Duffy said cancer clinics had recently started ‘upping their game’ in terms of accepting referrals, which she argued was also resulting in the increase.
She added: ‘This time last year, maybe May/June, nobody was being seen for anything, even breast lumps and things like that.
‘There will be some adversely affected by this because there would have been a delay in the pickup. It could be that they didn’t come in when they felt, for example, that breast pain initially but it may not have always been by choice, it could have been that we didn’t have the availability to see them but we do want to see them and encourage them to contact their GP and talk about it if they’re concerned.’
Since last month, an additional 2,106 patients have been added to groaning hospital waiting lists.
A total of 883,727 patients across the health service are now waiting
‘Later-stage cancers mean fewer options’
‘We encourage them to contact their GP’
for care, according to the National Treatment Purchase Fund.
A record 630,305,756 people are now on the outpatient waiting list – an increase of over 67,000 (12%) in the past year and an additional 18,222 since October 2020.
Hospitals experiencing the highest increases in outpatient waiting lists over the past year include: Cork University Maternity Hospital (81%), Mayo University Hospital (46%), St Michael’s, Dún Laoghaire (40%), Wexford General Hospital (33%), Galway University Hospitals (30%), Cork University Hospital (26%), Royal Victoria Eye & Ear (25%), Naas General Hospital (25%)
For those awaiting hospital treatment, there are big increases over the past 12 months in the inpatient/ day case waiting lists, particularly in: Croom Orthopaedic Hospital (205%), Naas General Hospital (161%), Wexford General Hospital (115%), MRH, Mullingar (101%), Mallow General Hospital (78%) and St James’s Hospital (49%).