Fear over fast-track cancer therapy

By MARTIN JOHNSTON health reporter

Cancer specialists are concerned for the safety of patients receiving concentrated courses of radiotherapy in an effort to cut waiting lists at Auckland Hospital.

Some patients are receiving larger doses of radiotherapy over shorter periods.

Auckland Hospital says the practice is safe, but specialists in Wellington and Sydney say it puts patients at a higher risk of future complications.

National Party health spokesman Roger Sowry says the Health Ministry is urging other hospitals to follow Auckland, something the ministry denies.

The shortage of radiation therapists is causing new breast-cancer patients to wait up to 18 weeks for radiotherapy in Auckland.

Therapists in Auckland, Hamilton and Palmerston North plan to strike for 48 hours from December 3 seeking 20 to 25 per cent pay rises.

Dr John Childs, head of radiation oncology at Auckland Hospital, said last night that the hospital adopted the quicker treatment for post-operative breast-cancer patients nearly a year ago.

The course involved the same overall amount of radiation, but administered in fewer sessions of larger individual doses over four weeks instead of five.

The change was introduced partly because of lengthening waiting lists, but also because it was more convenient for patients, he said.

"Our clinical opinion is that within the range of dose that we are using in Auckland, there is no clinical safety issue. We would not use it ... if we believed there was."

He said this opinion was based on international evidence.

But Dr David Lamb, Wellington Hospital's head of cancer radiation services, said five weeks was the international standard for treating breast cancer patients after surgery to remove a lump, plus an extra week in some cases for radiation directed at where the lump came from.

"We have very little evidence to say that altering the schedule away from what is standard is safe practice."

With the shorter treatment, there was a risk of damage to nerves and tissue that could appear years later.

Dr Gordon Adler, a specialist at the Sydney Adventist Hospital, where some New Zealand women are being treated, said last night that post-operative breast-cancer patients were treated over at least five weeks.

"I believe this programme that we provide is so reliable and effective that I would be extremely reluctant to accept a shorter course as being as good."

Those offering shorter courses had to reduce the total dose or accept a higher risk of complications in future years, such as damage to nerves and blood vessels, he said.

"I'm not saying a four-week course is going to do that necessarily," he said, adding that the risk of breast complications from radiotherapy was fairly small.

The Ministry of Health said it was not urging other hospitals to follow Auckland. It had simply asked radiation oncologists to explore the practice - which was also used in Canada and Britain - as an option for reducing waiting times.

Mr Sowry cited Waikato District Health Board papers which he said indicated the request was being discussed seriously by health boards.

"This proposal is not from specialist radiation oncologists who have the clinical expertise in the area, and there are serious question marks over whether or not this is a safe practice.

"This is not a time to experiment, this is a time to find the resources for cancer treatment."

Ministry spokesman Andrew Holmes said patients' best interests were being kept in mind. Doctors were being asked to consider whether more intensive treatment might be preferable to a long wait.

nzherald.co.nz/health