Thursday, 23 June 2016
Topical Issue Debate
Cancer Services Provision
I recently received correspondence from a sarcoma patient. I do not want to divulge the name of the patient even though she has subsequently raised the issue on social media. It is quite a distressing email in many ways. As the Minister should be aware, sarcoma is a fairly rare type of cancer. It accounts for about 5% of all cancers. We presently have about 200 to 250 patients who present with this disease every year in Ireland. This sarcoma patient has been attending a particular doctor in St. Vincent's Hospital. The doctor specialises in this type of cancer and has more than 300 patients in her care as we speak. Now, the patients are horrified to learn that this talented, hard-working and knowledgeable doctor is being let go by St. Vincent's. The patients feel that the proposed replacement, while vastly experienced, does not have the sarcoma expertise and also has a very busy private practice. In short, 300 patients are sceptical that they can get the same care and attention that they currently get.
St. Vincent's Hospital, Dublin is in the privileged position to have a wonderful resource at a centre of excellence with the treatment of sarcoma in its oncology unit through a particular consultant who is among the few worldwide experts in the treatment of sarcoma. This centre of excellence which has been established over the past three years has given treatment and hope to hundreds of sarcoma patients, enhancing survival rates and in many cases making survival possible where previously little hope was given. The patients feel that this kind of expertise in such a rare cancer takes years and years of research and experience. Regrettably, this is about to change when the contract of this invaluable resource is to be terminated.
The patients do not seek to comment on the contractual issues of any member of the HSE, but to highlight how the loss of this expert resource will impact on the care and treatment in the future. This level of knowledge, experience and expertise of sarcoma cannot be replaced by an expert in another field of cancer. Yet, it seems that this is about to happen. Patients are frightened for the future. One e-mail I received described the feeling of having finally found a place that feels safe and offers so much hope, only to see it about to be taken away, not just from the 300 of today's sufferers but from the sufferers of next year and the year after. They are frightened and they want to keep this particular oncologist expert in sarcoma. If we continue with her employment, the patients are confident that we will see the survival rates improve to secure the future lives of many children and young adolescents who are about embark on lives they have every right to enjoy.
The patients that have received excellent treatment in St. Vincent's are very concerned that this particular expert in the area who has built up a wealth of knowledge and experience over many years will have her contract terminated shortly. They do not believe that the replacement can bring the same level of support and service that they require and need for what is a very challenging disease and illness. It is life-limiting in many cases. I recall the e-mail I received that spoke of having finally found a place that feels safe which is now about to be taken away.
I welcome the opportunity to speak about sarcoma services at St. Vincent's University Hospital, Dublin. I thank Deputy Kelleher for raising this important matter. Sarcomas are rare malignant tumours that arise from transformed cells of the connective tissues, such as muscle, fat, cartilage or bone. I acknowledge that people who have been diagnosed with sarcoma, or any other serious illness, will of course be concerned that they receive the best care and treatment. That is a concern that I share.
As the Deputy said, services for the management of these patients with sarcoma are currently provided in St. Vincent's Hospital as well as in Cork University Hospital. The multidisciplinary team in St. Vincent's Hospital has all of the relevant specialities represented, including surgery, medical oncology, radiation oncology, radiology and pathology.
Recently, a consultant medical oncologist was employed by St. Vincent's Hospital on a locum contract to provide cover for one of the other consultant medical oncologists who had taken on the role of chair of the Irish clinical oncology research group. This consultant has now returned to his post at the hospital. The reason for employing the locum has now ceased. That locum was only ever filling a role on a temporary basis while the consultant medical oncologist took up the role of chair of the research group. I have made inquiries about this because I have been contacted by a number of people and I am assured by the HSE that care for patients undergoing treatment for sarcoma cancer at St. Vincent's Hospital will not be compromised in any way and their management will be provided by one of the hospital's full-time oncologists.
In relation to sarcoma services nationally, a national clinical lead in soft tissue sarcomas has been appointed to oversee the services for patients with sarcomas. All Irish patients with sarcoma have their cases presented and discussed at one of the two sarcoma multidisciplinary teams. The HSE's national cancer control programme, established in 2007, has reorganised and expanded cancer services to achieve better outcomes for patients and has moved the system of care to one that consolidates cancer treatment in larger centres with multi-disciplinary care and decision-making. These services are provided regardless of income, age and location.
Long-term survival for all cancers has improved markedly with five year survival rates increasing from 57% for patients diagnosed between 2003 and 2007 to 61% for patients diagnosed between 2008 and 2012. It is expected that survival rates will increase further due to the combined approach of screening, symptomatic detection and improved treatment.
My Department is currently working on a new national cancer strategy for the next decade. This will build on the progress made through the implementation of the two previous strategies. Areas of focus are likely to include prevention, early diagnosis, further improvements in treatment, rare cancers, survivorship and high quality, patient-centred care. I intend to publish the new strategy in the coming months.
As I said at the outset, I want to acknowledge the concerns people who have been diagnosed with sarcoma have in relation to their care. However, I wish to pass on the reassurances I have been given by the HSE that there will be no reduction to the service provided by the St. Vincent's Hospital's oncology team. I welcome the opportunity to clarify this issue.
There are two issues that arise from the Minister's reply. The first is that the reason for employing the locum has now ceased because of the return of the other consultant oncologist. The point I am trying to make on behalf of the patients who have contacted me is that the locum that is currently there has provided a wonderful contribution and rather than losing that expertise, the locum could be maintained and the returning consultant oncologist I am quite sure would find plenty of other work in St. Vincent's.
On a comparative basis, the criteria for the care of sarcoma patients in England and Wales, for example, reads quite long compared to what we are probably offering in this country. There is a sarcoma medical group consisting of all specialities including surgical, orthopaedic and medical oncologists, radiologists, pathology and oncology nursing as well as rehabilitation services. At least one group member belongs to a sarcoma-oriented medical organisation, such as the Connective Tissue Oncology Society. Publications are produced concerning sarcoma in peer review journals. Sarcoma conferences take place where sarcoma groups meet at least once per month to discuss patient issues. At least 50 sarcoma patients are seen per year. There are other issues such as MRI, imaging and pep scans, patient enrolment in clinical trials, strong support of personnel such as social workers, pathologists and psychiatrists and sarcoma support groups where desired.
The doctor that I am speaking about has published in a huge number of journals that prove her expertise in the treatment of this disease. I know the Minister is not questioning that. She has contributed to 13 publications and has 42 citations. While there is an assurance given that the service will not be reduced, what we want to try to do is enhance the service. If the locum was maintained, rather than maintaining the service, we would actually be enhancing the service. I hope the Minister will convey the views that I have conveyed to him as those that have come from the patients themselves.
I will convey Deputy Kelleher's views and the views of the patients who have contacted him to the HSE. They are similar to the views expressed by patients who have contacted me. From what the Deputy told the House and from what I am informed by patients as well, there is no doubt that this locum did an excellent job. That is beyond question. The locum clearly had a positive impact on patients and on patient care. I am grateful for that. In the interests of clarity, this was always a locum position. The locum was filling in for another consultant oncologist who had undertaken a prestigious role as chair of the research group. It was always the understanding that the locum, by nature of being a locum, would carry out the duties of the consultant oncologist until that consultant returned to his post. He has done that. The multidisciplinary team in St. Vincent's University Hospital has all of the relevant specialties represented, including surgery, medical oncology, radiation oncology, radiology and pathology. The hospital has reassured the national cancer control programme that patients' ongoing care and management will be provided by the hospital's oncology team and will not be compromised in any way during the hand over period.
However, I accept the broader point made by Deputy Kelleher, which is valid, as to whether there is a case to be made for an additional consultant post with a special interest in the area of sarcoma. I have raised this with the HSE and have been assured by it that consideration is being given to appointing a permanent consultant medical oncologist with a special interest in sarcoma. I will revert to the Deputy on it, given that the HSE is actively considering it. Also, the Deputy referred to international comparisons. Since the establishment of the Irish Sarcoma Group in 2014 we have strengthened and developed our national sarcoma services. International links have now been developed with specialist sarcoma centres in the UK, which the Deputy mentioned, and in Germany. These international links are important to ensure we have best practice.