Oncology Delays At Waikato Hospital
August 19, 2002
Oncology Delays At Waikato Hospital
The New Zealand Breast Cancer Foundation says that women with breast cancer are being told to consider having a complete mastectomy rather than breast-conserving surgery because vital post-operative radiotherapy and chemotherapy cannot be administered within recommended guide times.
Oncology service delays at Waikato Hospital have fallen so far behind that doctors believe they have a "legal and moral obligation to tell patients of the unacceptable risks," according to the clinical director of oncology services, Dr Jeremy Long.
Breast surgeon, Dr Ian Campbell, of Hamilton, says some women are opting for complete removal of the breast rather than gamble on a delay.
"It's a grim position to be in when we can't give patients what they require ... and if there is a major delay [of radiotherapy or chemotherapy] then it increases the risk that the operation will not be successful," says Dr Campbell.
Delays in accessing medical oncology for adjuvant chemotherapy are also significant and Dr Long says he and two colleagues are being overwhelmed by the number of referrals for treatment which is only available at the public hospital. There are no private oncology services in Hamilton.
Dr Belinda Scott, breast surgeon and chair of the Foundation's medical advisory committee, says that chemotherapy must be given within a certain timeframe to women with breast cancer.
"A delay in receiving chemotherapy will affect how long these women will live. That is why we [the Foundation] are so concerned about this situation."
The national guideline is for an oncologist to treat between 180 and 220 patients a year. In the Waikato they are seeing about 250 patients a year.
Dr Long says: "We need five oncologists at the current growth rate, not three, but we only received approval to employ a fourth in August last year - that's if we can attract one. Part of the problem is a world-wide shortage of oncologists in both radiotherapy and chemotherapy.
"We did manage to engage a locum from the United States for three months at the beginning of this year and got the waiting time for treatment down to zero, but now it's soared again to unacceptable levels.
"Some patients requiring radiotherapy have been sent to Australia for treatment [paid for by the district health board] and a few have sought private chemotherapy from oncologists in Auckland.
"But not many people can afford private chemotherapy which is not well covered by medical insurance. It's a matter of having your own financial resources. These people get some help until such time as their appointment date arrives with us and then they're free to come here [there are no private radiotherapy facilities in New Zealand; only the public health service is prepared to meet the high cost of equipment]."
Dr Long says referral rates for oncology are now twice the hospital's contracted level -"it's shocking."
He says the waiting times have been reported to the Waikato Hospital management and also to the Ministry of Health which has received them without comment.
"We are so deeply concerned at the rising numbers that we have approached the chief medical adviser of our hospital to say that these waiting times are unacceptable and we believe legally and morally that we need to inform people of the situation. This request is still being considered. Meanwhile radiotherapy [waiting time] is way out and chemotherapy has crept out quite significantly and we're unbelievably upset about it."
He accepts the situation is not unique to the Waikato. He understands Palmerston North may be experiencing similar difficulties. Auckland has only managed to peg back waiting times to acceptable international levels in recent months.
"The fact of the matter is that there's just too much work. We are diagnosing some malignancies much earlier while we are treating other forms of cancer which we weren't previously, all of which has added to our case load."
Dr Long says Waikato has managed to recruit three radiation oncologists overseas who will be arriving toward the end of the year. They will help get waiting times back but this is only one part of the problem as there is still a shortage of radiation therapists and medical physicists.
Dr Scott says that clearly these clinicians are under incredible pressure and the health system needs to address its priorities.
"It is absolutely appalling that there has been no action taken to rectify this situation, let alone acknowledgment of the clinicians' concerns."
Released on behalf of The New Zealand Breast Cancer
Foundation by Porter Novelli New Zealand (Auckland) Ltd.