Patience for changes helps patients with cancer

Hawke's Bay's slow response to increasing government targets for cancer treatment is good for patient outcomes, says the clinical lead for Hawke's Bay District Health Board's Faster Cancer Treatment Governance Group Elaine White.

"We want to make sure we don't do something that is a flash in the pan - we want something that is sustainable," Dr White said.

In the last two Health Ministry targets, released quarterly, Hawke's Bay has ranked last.
The target was 85 per cent of patients receiving their first cancer treatment within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. The national average is 82 per cent, well below the 90 per cent target from this month.

Dr White said on average 19 people were diagnosed with cancer every month in Hawke's Bay but more than 100 would be diagnosed with other ailments through very complex systems under review. Children with cancer were treated at Auckland's Starship Hospital.

Dr White provides clinical oversight for Hawke's Bay changes while Andy Phillips' job is to make changes so cancer treatment is faster.

"What other DHBs might have done - we know they have done - is meet the targets but not respect the clinical need of patients," he said.

"It would be easy for us to meet the target by operating on slow-growing cancers such as prostate cancer - but what we want to do is make sure the patient gets the right treatment for the best outcome."

He said if the right changes were made the Ministry's target would result in better patient outcomes.

"Setting a six-hour target in the Emergency Department has resulted in fewer deaths - we have good evidence for that across the country. Setting targets for cancer treatment is a good idea and we think it will lead to better outcomes. That hasn't been evaluated yet in New Zealand although it has been evaluated in other countries."

He said clinicians respond "very badly" to imposed targets "so we have said it's about improving outcomes for people - that is the crucial thing."

The target would be achieved through sustained improvement for patient need and he was confident Hawke's Bay would climb the table.

"It is all little things that are going in tandem. We are building the platform to make it happen and when it all comes together we should have synergy."

Part of the improvement was co-ordinating expanded capabilities in areas such as radiology, surgery and the endoscopy unit under construction.

The cost of doctor visits, transport (travel assistance is income tested ) and personal choice were big barriers to timely treatment - some people went on holiday mid-treatment.

"Our big problem is people tend to arrive far too late and in an advanced state of disease. They quite often turn up at the Emergency Department or through primary care and in a late stage of cancer, by which time it is quite difficult to do anything. We are talking about forms of cancer which aren't painful and in late stages. You can have very late stage lung cancer and have no pain at all - a persistent cough doesn't go away or bleeding from places you shouldn't be bleeding from."

The biggest improvement of all would be from people simply visiting their doctor more often. Screening programmes lifted breast cancer survival rates to 90 per cent "so it is about catching things in the early stage".

While one out of every three people will get cancer at some stage in their life a healthy lifestyle, quitting smoking and weight loss reduce the odds dramatically.