The crisis has forced Te Whatu Ora Health New Zealand to set up the country’s first national cancer working group.
The group is working on “a national clinical network with the goal of establishing a sustainable radiation oncology service for Aotearoa,” the agency said.
Dunedin Hospital has in recent weeks had to suspend key services for patients with brain tumours, gynecologic cancer and benign tumours, as well as some forms of stereotactic treatment for which it has the national contract.
“There are certain services for certain conditions in the south [district] has no more expertise to provide,” the Cancer Control Agency said.
In a region that has been starved of cancer specialists for years, the pressure has really mounted since November.
It has left Dunedin with less than half of the eight or nine radiation oncology consultants it needs to serve Aotearoa’s 300,000 southernmost people. It has only 3.8 full-time equivalents.
One of those consultants is retiring, one is in his sixties and RNZ understands that the other two are trying to move elsewhere.
The district tries to recruit, but during a global shortage of oncologists.
Costly health funding that Dunedin could have built up is increasingly being paid for long stays of transferred patients, and for private clinics called upon to reduce waiting lists.
It’s at a point where Dunedin could be stripped of its accreditation to train new oncologists if it can’t guide them.
The crisis has shifted the burden, particularly to Christchurch, where southern patients now have to travel for treatment. They stay there for up to six weeks at the taxpayer’s expense.
‘Slow moving train wreck’
Brain Tumor Support Trust spokesperson Chris Tse said it was “a slow-moving train wreck” causing delays and shortened lives.
“There’s a patient who was diagnosed with glioblastoma, an aggressive brain tumor, in December,” he said.
“By mid to late February, they still hadn’t seen a radiation oncologist.”
A six-week delay in treatment can shorten survival by three months.
Tse knew of patients who lost follow-up care from a radiotherapist-oncologist and were now referred back to neurosurgery or another department, which was not ideal.
Oncologists warned last August “we have reached the point of no going back”.
Dunedin holds the national stereotactic contract and accepted a small number of non-cancer referrals until December 2022. Many other neighborhoods don’t.
Stereotactic surgery is a minimally invasive form of surgery that uses a 3D coordinate system to locate small targets in the body.
Dunedin continued to accept referrals for malignancy treatment, while the national clinical network of experts “come together to discuss how to continue to support this service … for non-malignant patients,” Te Whatu Ora said.
For less complex cancer cases, patients were asked about transfer outside the Southern District, “to help support current local capacity constraints and to ensure patients have access to timely treatment”.
For more complex cases, a “virtual” meeting with a radiation oncologist was more common to decide on treatment, with that treatment delivered locally in Dunedin by medical physicist, radiation oncologist and nursing staff, with registrars and supervising radiation oncologists on hand, it said. .
National Cancer Group founded
The Southern District Health Board said that of patients whose cancer could still be treated, 90 percent were treated within the stated waiting times.
But only 63 percent of patients got their first appointment with a specialist within specified times.
The waiting list stands at 133 patients, down from 143 earlier in March but up from 114 in February.
Some high-priority patients, instead of seeing a doctor within two weeks, saw one in four to six weeks, the district said.
It wasn’t until RNZ inquired about this that Te Whatu Ora revealed that the crisis in the south forced it to set up the country’s first national cancer task force a month ago.
Nationally coordinated cancer care would be unprecedented, said Nicola Hill, acting chief executive of Cancer Control Agency, an advisory body to Health NZ.
This was “to try to ensure that whatever pressures exist in a particular region, patients can be seen”.
“There’s only so much support Canterbury could provide,” so other major hospitals stepped up, Hill said.
Staff praised local leadership in Southern, but were frustrated with spending months addressing the evolving cancer crisis with Te Whatu Ora, receiving little leadership or workable solutions — and, in fact, struggling to even know on which bureau this falls to the sprawling centralized bureau.
‘Vacancies of great importance’
A 2021 report from the consultants EY, focused on saving Southern, said Southern needed 7.7 radiotherapists. This would allow the net to overtake the second most understaffed service, MidCentral.
Te Whatu Ora said his response to the tightness was to transfer patients and add a full-time observer for a fixed term in mid-2023.
It also involved teleconsultations with three doctors elsewhere. However, this poses problems for patient examination and follow-up treatment.
Te Whatu Ora had also agreed to train five additional registrars across the country this year.
If Dunedin is stripped of its training capacity in May, when the evaluators do their five-yearly check, it would increase the pressure on other hospitals.
They would need to hire Dunedin’s four registrars, as well as the five new interns, which would add to the workload of senior doctors, who already average 55 hours a week for much less pay than in Australia.
But “it’s one of the few ways this problem can be solved,” Hill said.
Te Whatu Ora refused to be interviewed.
Instead, Southern Regional Director of Hospital and Specialty Services Dan Pallister-Coward issued a lengthy statement.
The six centers had added 24 staff over the past year, he said.
However, many of them are junior or administrative staff, not senior doctors.
“Waiting times in radiotherapy oncology and vacancy challenges are a national issue and not specific to the South.
“Current national … job openings are a major concern,” Pallister-Coward said.
Another way to ease the pressure was to pay private clinics in Christchurch and Wellington to treat public patients, which could be expanded, he said.
Hill said he had not heard of capacity problems at the private clinics.
In general, however, private practice prefers not to take on cases that look like they could be difficult or lengthy.
Tse said that for patients who may have to pay to go private, that was another obstacle.