Colonoscopy data lack decried
It’s a “national disgrace” that Te Whatu Ora is not recording or publishing the number of colonoscopy referrals being declined, cancer advocate Melissa Vining says.
“This is a critical piece of information for the public to understand the performance of the service.” Tracking referrals and decline rates was important because the intervention rate would help health officials understand why so many cancer cases were diagnosed late, she said.
While the number of colonoscopies being delivered in the public health system has been increasing steadily, so too has the demand, and advocates believe it’s not possible to truly understand the unmet need without data on referrals and exactly how long people are waiting over recommended time frames.
Nationally, 16,805 were waiting for colonoscopies in November, while 6986 had been waiting longer than recommended and 3875 longer than the maximum wait time considered clinically safe – 30 calendar days for urgent, 90 calendar days for non-urgent, and 120 calendar days for surveillance.
In November 2022, 15,516 people were waiting for a colonoscopy and 6179 had been waiting over the recommended time frame, while 3805 had been waiting longer than the maximum.
Data from the past 12 months showed at most, 87% of patients were getting their urgent colonoscopies within 14 days. About 50% of patients were getting their non-urgent scopes within 42 days and between 53% and 64% were getting their surveillance procedures within 84 days.
Te Whatu Ora does not publish data on the number of days people have been waiting over recommended time frames and a request for average wait times under the Official Information Act was refused.
OIA manager Danielle Coe said: “Health New Zealand does not hold information about longest or average wait at a national level. In order to provide this, we would need to divert personnel from their core duties to search through patient level records.”
A spokesperson for Te Whatu Ora said: “Each area keeps track of their colonoscopy referrals, including the numbers that are approved and declined, and will monitor the length of the time patients are waiting to be seen.” But this data was not held at a national level, the spokesperson said.
After pouring over the data that was available, Bowel Cancer NZ medical adviser Professor Frank Frizelle said he was surprised by “the huge number of people that are not getting treated”. “It doesn’t seem to be getting any better and that’s disappointing.”
Without knowing how many people had been referred for colonoscopies, you could not tell how many people were not being looked at, Frizelle said.
The factors driving an increase in demand included an ageing and growing population, and that people were more aware about the symptoms they should test for, he said.
“Demand will continue to grow.One has to recognise that bowel cancer is changing,” Frizelle added, pointing out that it was increasingly impacting younger people. He urged Kiwis to take some personal responsibility and work with their GPs to modify lifestyle factors to lower their risk of cancer.
Bowel Cancer NZ nurse support co-ordinator Victoria Thompson said the organisation had been calling for the Government to increase work force capacity since 2010.
“We are now in a situation where there are simply not enough gastroenterology or endoscopy specialists to treat patients in New Zealand. We know people are experiencing unacceptably long wait times, so where is the Ministry of Health’s plan for managing this?”
In 2020, University of Otago cancer researcher professor Brian Cox and Canterbury Charity Hospital founder Phil Bagshaw wrote in a New Zealand Medical Journal editorial that colonsocopy services were not properly resourced before the national bowel screening programme was released, putting more pressure on the service.
“Resolution requires a rapid increase in the number of physicians, surgeons and nurses with an interest in gastroenterology,” they wrote.
Stuff asked Health Minister Shane Reti what work was being done to improve colonoscopy services and whether he thought Te Whatu Ora should be collecting more data to understand the level of unmet need in New Zealand.
A spokesperson for the minister’s office said he had requested advice on the matter and was considering it.
“As was the case with the recent announcement to raise the age of breast screening, any decision to adjust eligibility for screening has significant clinical, work force and funding implications to consider,” he said.