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New Director of the HSE National Cancer Control Programme, Dr Susan O’Reilly addresses the inaugural NCCP National Symptomatic Breast Cancer Services Forum.

The HSE National Cancer Control Programme Symptomatic Breast Service now has the essential elements to establish it as a world class service.  Addressing the inaugural NCCP Symptomatic Breast Services Forum in Dublin today, Friday, October 8th, the new Director of the Cancer Control Programme, Dr Susan O’Reilly will comment on the significant improvements that had been made since 2007, pointing to the emphasis now on building on the quality of the service through regular audit and rigorous risk management.

Having become the first such Irish health service to be independently audited by HIQA, the NCCP Symptomatic Breast Service emerged positively from that process earlier this year, with the independent body confirming that all the essential elements for a quality service were now in place across the eight designated cancer centres (inclusive of the satellite unit at Letterkenny General Hospital).

With the final transfer of breast cancer services having taken place last December - when the new breast unit was formally opened in Cork University Hospital - the expert teams from the eight centres are today meeting in Dublin for the first of what will become an annual forum to allow the sharing of good practice, the promotion of learning and the building of the network of centres to ensure standardisation and service improvement.

The gathering will bring together cancer experts in radiology, pathology and surgery as well as clinical nurse specialists and data analysts.  With the latest data projecting a 60% increase in the number of women seen by the Symptomatic Breast Services since 2006, the Forum will be examining the challenges that such increases have posed.  

Confirming that today’s Forum will become an annual gathering, Dr Susan O’Reilly said that the NCCP were planning to introduce similar events for other cancers:  “This is a very important milestone for the National Cancer Control Programme. It is very clear to national and international observers that Ireland has made significant strides in the development of its cancer services over the past three years. 

“Today brings together many of those individuals in the symptomatic breast service who made the plan a reality – the doctors, nurses and analysts who made the concentration into the eight centres of the symptomatic breast services work and work well.

"In coming together today, we will reflect on the significant experience that we now have available.  This will allow for greater standardisation, greater audit and greater examination of the services we are delivering.”

It is anticipated that there will be a 20% increase in the number of women attending the clinics in the eight centres this year compared with last year, according to NCCP figures. A total of 31,700 women were seen in the clinics in 2009 and projected figures for 2010 show that by the end of the year over 38,000 women will have been seen at the specialist breast clinics.
While the number of cancers being diagnosed remains relatively static – 2,600 women expected to be diagnosed in 2010 (with 2100 diagnosed within the public symptomatic breast service), the rate of survival continues to increase.

Ireland has already experienced a significant increase in survival rates over the past two decades and this is expected to increase over the coming decade through the impact of the NCCP, Breastcheck, the recruitment of additional specialist staff, the concentration of services at the eight centres, earlier detection and improvements in technology and treatments. Ireland’s five year survival rate of 80% is expected to steadily improve over the next ten years.

By the end of August this year over 25,340 women had been seen at over 1400 clinics in the eight centres. Compared with pre 2007 when symptomatic breast clinics were averaging one a week in hospitals across the country, women are now being offered appointments at the eight specialist breast clinics operating five days a week in some centres, with many offering evening and weekend appointments.

Every centre is now operating to a defined set of standards, targets and indicators against which they are measured and audited.  Committed to transparency through the phased publication of those targets and standards, the NCCP has already begun publishing the independently agreed access targets.  According to the HIQA standard, the centres should be seeing 95% of all urgent cases within two weeks of their initial GP referral and 95% of non urgent cases within twelve weeks.  The most recent data shows that those targets are being exceeded –  at the end of August 99.8% of all urgent cases were being seen within two weeks (ten working days) and 98.3% of non urgent cases were being seen within twelve weeks.
Figures now available for 2009 show that 9,413 women were seen within two weeks of their initial GP referral. That meant that on average over 180 women a week were seen in specialist breast clinics on an urgent basis, with a further 341 being seen every week on a non urgent basis.  With early detection a key element in increasing survival rates, the success of the eight centres in providing such rapid access to their services is clearly an important development.

According to Dr O’Reilly, standardisation is a vital component: “We now have clearly defined patient care pathways in our centres. The process – starting when the patient is first referred by their GP - is mapped out, clearly defined, standardised and it is the same in all eight centres. But more importantly, we have put in place systems that allow us to gather information on every significant aspect of that pathway. We have agreed a core set of standards that must be in place.  We require our centres to apply those standards and report back on them to us. 

“Prior to 2007 the service here in Ireland was fragmented. There were a lot of good clinicians but some were not working in an environment where the volume of work was in keeping with best international practice and experience.  While some were working in teams, this was not the case for all.  This was a loss to the patient in the first instance but equally it was a loss to the clinicians who did all not have the opportunities they now have to learn and develop.”

“However, it should be noted that while the transfer of surgical and diagnostics in the area of breast cancer is now complete, the NCCP is continuing to expand and develop in many other areas.  The majority of our rapid access clinics for prostate and lung cancer are now open – providing swift access for patients and facilitating earlier intervention.  We also are preparing to open our new radiation oncology units at St James and Beaumont hospitals as part of the St Lukes Radiation Oncology Network.

“We are also committed to developing our medical oncology services. Medical Oncology involves outpatient treatments such as chemotherapy which often require months of treatment for our patients but it should be remembered that these services are available in a network of hospitals across the country.

“For patients in the south east for example, while the designated cancer centre is in Waterford Regional Hospital – patients receive chemotherapy treatments in Wexford, Clonmel and Kilkenny.  In the west, chemotherapy is provided the satellite unit in Letterkenny, in Sligo General Hospital, Mayo General Hospital, Castlebar, and Portiuncula Hospita, Ballinasloe as well as in the two designated centres in Galway and Limerick. Kerry patients who now travel to Cork University Hospital for breast cancer diagnosis and surgery are also facilitated in receiving chemotherapy treatment in Kerry General Hospital in Tralee.  This is not an exhaustive list but it illustrates the significant network that exists.

“We in the NCCP are engaged in developing those chemotherapy services and this year to date, we have been successful in securing six additional Consultant Medical Oncology posts.  Most of these appointments are on a joint basis and will involve appointments to Sligo/Galway; Mater/Cavan; Drogheda/Beaumont; Cork/Tralee as well as to Letterkenny (linked to Galway University Hospital) and Limerick. It is clear therefore that we are building our network of medical oncology and will continue to expand the range of services that patients will access closer to home through the work we are doing in the community.”




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