Number of procedures carried out directly related to survival of patients surgeon treats, report finds
A five-year analysis of cancer services shows that highly specialised cancer surgery is still being carried out by general surgeons throughout the Republic.
The report, Surgical Procedures for Selected Cancers in Ireland: 1997-2002, which has been seen by The Irish Times, reveals that surgeon workload "is an important determinant of outcome for those who have surgery as part of their treatment for cancer".
The report was recently adopted by the National Cancer Forum (NCF), which is in the process of formulating the new national cancer strategy. It is based on data collected by the Hospital In-Patient Enquiry (HIPE) system covering 97 per cent of all discharges from acute hospitals.
The analysis divides hospitals into those with more than 300 beds, described as Band A facilities, and smaller units labelled as Band B.
In the case of breast cancer it found that, despite the recommendations of the 2001 O'Higgins report on symptomatic breast disease services, there was no reduction in breast cancer surgery in Band B hospitals.
These units perform fewer than 100 procedures per year and are not designated as centres of excellence for the treatment of breast cancer.
The total national workload for breast cancer increased from 1,333 surgical procedures per annum in 1997 to 1,854 procedures in 2001.
However, 60 per cent of consultants carried out fewer than 10 procedures a year, well below the level of expertise required to produce a reduction in deaths from breast cancer,
In relation to bowel cancer, the most common type found in the Republic, an analysis showed that three-quarters of consultants performed fewer than 10 operations on this type of cancer every year.
It also found that, while the total number of consultants increased from 109 to 134 during the five-year period, the percentage of surgeons performing fewer than 10 procedures each year increased from 40 to 55 per cent.
The procedures were a partial or total removal of the large intestine, aimed at eradicating the cancer.
In the case of cancer of the oesophagus (gullet), the NCF report found that more than three-quarters of consultants operating on people with the condition performed fewer than 10 procedures per year.
It also noted that 13 consultants in five health board regions carried out this highly specialised surgery.
The Irish Times understands that an unwillingness by individual consultants to change their practice is the principal reason for these trends.
Sources have indicated that it may also reflect pressures within health boards to maintain a broad range of local services.
According to a number of sources there is strong evidence to show that the volume of procedures carried out by a consultant is directly related to the survival of the patients he treats.
This is especially true for the treatment of cancers of the oesophagus, pancreas, breast and rectum, they said.
"This all-kinds-of-everything approach to cancer surgery will have to end," a specialist told The Irish Times last night.