Major treatment delays for women with some types cancer

Some women with cancer of the reproductive organs have experienced waiting times far longer than the Government's new target, putting them at risk of worse outcomes.

Only 39 per cent of Northland women with gynaecological cancers began treatment within the target of 62 days of their referral, according to an audit in today's NZ Medical Journal.

The target is that 85 per cent of cancer patients referred with high suspicion of cancer will start treatment within 62 days.

The national performance on this target for all cancers was 74 per cent of patients in the April-June quarter, the latest data available. Northland District Health Board was at 73 per cent.

Each year, nationally around 1000 women are newly diagnosed with a gynaecological cancer and around 400 women die from one of these diseases - around 10 per cent of all female cancer diagnoses and deaths. There are five main forms: cancer of the ovaries, cervix, endometrium, vagina and vulva.

In the journal paper, authors Catherine Askew and Anand Gangji say the average waiting time of patients in the audit for the 13 months to June 2015 was 111 days - with a maximum of 525 days - for those treated in Northland.

Many of the Northland DHB patients were treated at Auckland DHB and on average they had a quicker journey from GP to hospital treatment, at 80 days, with a maximum waiting time of 202 days.

"The Northland [treatment] data was significantly influenced by one outlier patient in which a revised histology [tissue test] report was lost and a malignancy diagnosis was delayed by approximately six months."

The greatest contribution to delays was in obtaining tissue diagnosis, especially when surgery was required to do the biopsy.

Multi-disciplinary meetings of specialists to plan cancer care also made a significant contribution.

The authors suggested training GPs to better recognise potential signs of gynaecological cancers because few of the patients in the audit were at first flagged as "urgent - high suspicion of cancer".

Auckland DHB's director of cancer services, Dr Richard Sullivan, said performance against the cancer target had increased rapidly since it was introduced earlier this year.

Performance for gynaecological cancers had improved too, but was worse than for all cancers counted together, Sullivan said. He attributed this to the diversity of gynaecological cancers and their complexity.

A major sign of them in post-menopausal women was bleeding, but only one in every 16 to 20 women with this would have cancer, he said.

Health Ministry acting chief medical officer Dr Andrew Simpson said the study provided a useful guide to Northland cancer services about where they could best apply their efforts to improve their results.

"The ministry welcomes the approach taken in Northland to understand what's happening and how to improve the care for their patients."

"The new national target monitors the patient's whole journey - from the tests and investigations needed to confirm a cancer diagnosis, through to all forms of first treatment, including surgery, radiotherapy and chemotherapy.

"We know that focusing on this 62-day timeframe helps to streamline care, reduce delays, and identify where the cancer pathway is working well and where improvements can be made."