NHS cancer hospital may have to delay or reduce treatment

Leaked memo says nursing shortage means patients could have to wait longer for chemotherapy, or be given less treatment

An NHS cancer hospital may have to make patients wait to undergo chemotherapy, or reduce the amount of treatment that dying patients receive, because it has so few nurses, a leaked memo has revealed.

Macmillan Cancer Support said the prospect of the Churchill hospital in Oxford in effect rationing life-extending and potentially life-saving chemotherapy was “deeply worrying”, especially for people dying of the disease.

The warning is thought to be unprecedented in cancer care. It is set out in an email from Dr Andrew Weaver, the chemotherapy lead, to fellow cancer specialists at the hospital.

Sent on 3 January, Weaver refers to the difficulties on the day treatment unit (DTU) caused by a shortage of specialist cancer nurses who administer chemotherapy.

He makes clear that limiting access to the treatment could affect both newly referred cancer patients and those in their final weeks or months of life.

Weaver writes: “Currently we are down approximately 40% on the establishment of nurses on DTU and as a consequence we are having to delay chemotherapy patients’ starting times to four weeks.”

Two types of cancer patients will continue to receive their chemotherapy as normal: dying patients undergoing their first course of chemotherapy and those who are receiving it in addition to other cancer treatment, such as surgery or radiotherapy.

In future, however, dying patients could receive less chemotherapy as a result of the lack of nurses.

Weaver said: “We propose that for second, third and fourth line palliative treatments the cycle length is increased by one or two weeks and/or the total number of cycles administered is reduced – for example, where normally six cycles are given then teams should consider reducing to four cycles in total.

“I know that many of us will find it difficult to accept these changes but the bottom line is that the current situation with limited numbers of staff is unsustainable in the short, medium and long term. Sadly we cannot see the staffing levels on DTU improving for at least 18-24 months.”

Dr Karen Roberts, Macmillan’s chief nursing officer, said patients’ lives could be shortened if the hospital implemented Weaver’s proposals.

“Such a situation is deeply worrying and delays cause untold distress to patients. A group who may be particularly affected by such a decision would be those who have treatable but not curable cancer.

“Chemotherapy can help relieve their symptoms, extend survival and enable people to spend precious time with their family. If access to treatment is reduced, all these factors may be affected.”

Oxford Universty hospitals NHS trust, which runs the Churchill, said it had not decided to implement any of the suggested measures, but did not rule out doing so.

“We have not made any decisions to delay the start of chemotherapy treatment or to reduce the number of cycles of chemotherapy treatment which patients with cancer receive,” it said in a statement.

“We would like to reassure our patients that no changes to chemotherapy treatment have been made or will be made before thorough consideration has been given to all possible options.”

David Bailey, a nurse with the trust who is being treated for cancer at the Churchill, said the high vacancy rate for cancer nurses, and any consequent reduction in chemotherapy, would affect the outcomes for patients..

“I am lucky, I’m part of a clinical trial, which will not be affected; but how frightening is this for other, newly diagnosed cancer patients?”

Source: https://www.theguardian.com/society/2018/jan/10/nhs-cancer-hospital-may-have-to-delay-or-reduce-treatment

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