By: Godwin Ehienomen Gracious and Cian O’Broin
Approximately 294 cancer-related appointments were cancelled within University Hospital Limerick between March and December 2020.
The HSE National Service Plan 2021 sets out to implement the priorities of the National Cancer Strategy 2017-2026, which is predicated upon the prevention of cancer, early diagnosing as well as the provision of optimal care to patients and maximising their quality of life.
The COVID-19 pandemic led to a lockdown of non-essential services and significant challenges to the national healthcare system, with the closure of elective and day care cancer procedures and outpatient clinics.
On February 4th, 2021, University Hospital Limerick’s Medical Oncologist Dr. Greg Korpanty stated: “Over the last 12 months, I have seen more cancer patients presenting with advanced disease, due to the Covid-19 pandemic.
“As an oncologist, these are worrying times and we need to be prepared for an influx of cancer patients with more advanced diseases and late diagnosis when this pandemic nears a conclusion,” he added.
The University hospital Limerick (UHL) are one of the eight cancer centers that form part of the HSE National Cancer Control Programme (NCCP).
On January 5th, 2021 UHL Hospital group announced it would be reducing elective activity as Covid-19 activity surged. Their cancer services include tests to diagnose cancer, surgical cancer treatments, oncology consultations, chemotherapy and radiotherapy treatments.
The cancer services that would continue are oncology and haematology day ward; haematology and oncology OPD clinics; medical oncology clinics; rapid access clinics and Ward 4B appointments.
Services like chemotherapy, radiotherapy and surgical cancer treatments did not make the list of services that would continue.
“We are currently under considerable pressure but managing. However, no healthcare system could continue to cope with the current rate of increase in community transmission; hospital admissions and ICU admissions,” stressed UHL Hospitals Group CEO Colette Cowan.
Under a Freedom of Information request, the University Hospital Limerick disclosed exclusive details of a total of 294 recorded cancer related appointment cancellations between March and December 2020.
Figures show that 12 appointments were cancelled by the hospital due to the death of one patient, patients care transferred to Palliative inpatient in Milford Hospice as well as original bookings for appointments that were made in error.
A total of 235 appointments were personally cancelled by patients due to the transfer of care elsewhere and the decision of patients to request to reschedule to a later date.
The FOI also stated that 47 appointments were either unknown or not recorded if cancelled by the hospital or cancelled by the patient.
In a report entitled Cancer Services in Ireland in the context of Covid-19 released by the HSE on December 17, 2020, details outline that cancer survival rates in Ireland are increasing, with five-year net survival for patients averaging 63% based on follow-up during 2012-2016. This is up from 42% for patients diagnosed during 1994-1999. More recent data up to 2020, is yet to be published.
The report also stated that 190,000 individual cases of an invasive cancer have been diagnosed in Ireland since 2018, with the number of survivors by the end of 2020 estimated to be close to 200,000. This equates to approximately 4 per cent of the population.
A number of agreed principles were set out as part of The Covid-19 National Action Plan, outlining the continued delivery of cancer services as a top priority.
These include: the continuation of treatment following consideration of the risk to benefit ratio of treatment for each individual patient, continuation of diagnostic services, the prioritisation of time-sensitive treatment, reviewing the location of the delivery of cancer services to optimise patient safety and infection control as well as optimising the potential for providing cancer services in private hospitals.
Last year, essential cancer screening checks were paused until October 27. Breast checks saw a backlog of 153,000 screening invitations due to the impact of COVID-19. The report stated, “Due to the impact of Covid-19 and reduced capacity, the National Screening Service advise that it would potentially take three years to complete this current round of screening compared with usual 24-27 months.”
County Clare native Liz Canny was diagnosed with Stage 4 breast cancer in March 2019. Liz has been feeling the brunt of the availability of limited cancer services throughout the pandemic and last year was appointed ambassador for the Marie Keating Foundation in line with October, breast cancer awareness month. Since March 2020, she has been cocooning due to the vulnerability of her cancer.
She understands that what we know about cancer constantly changes. “After going for a family assessment, things may change,” she stated. Assessing your family history is key, Liz feels. This is what happened in her case. A risk assessment was done 10 years previous to her diagnosis, but the information had changed, unbeknownst to her.
“Early detection and early treatment are key to your survival. People aren’t dying from; they are living with it. I am one of those. By the time they found mine, it was already in my bones. There has been such progress with the drugs now that it’s not necessarily a death sentence.
“Women need to know what breast tissue they have. If you have a dense breast tissue, you may need an ultrasound as well, Liz informed. She admonished that if any sort of lump is felt or change in the breast, it is imperative to go and check it out. “Don’t be put off by Covid,” she declared.
Individuals living with a cancer diagnosis like Liz, have also had limited contact with Cancer Support Centres. These centres provide essential cancer related services and treatments such as lymph drainage, acupuncture, reflexology, meditation and palliative aids. Many, such as the West Clare Cancer Centre which services patients that attend UHL for cancer treatments, are suffering financially.
Committee Chairman Willie McGrath stated: “Everyone is aware that West Clare is so isolated from all facilities that are needed when someone is diagnosed with cancer. We are a locally based registered charity here in West Clare and there is nobody else to turn to.
“Each cancer patient costs the centre around €4,500. If you have a situation where you have a family member that has been diagnosed and has to travel to Limerick for eight to ten weeks, there may be nobody there to drive them”.
The HSE have stated that the effort to clear the backlog of cancer related cancellations is not expected to commence until Autumn at the earliest.
The return of services is projected to take place in three phases in 2021: March to June; July to September; and October to December.