Western Mail (KC) 05-May-08

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Better system could cut cancer deaths

SIR – Last week the Wales Cancer Conference organised by the Wales Cancer Institute and the Wales Cancer Alliance took place here in Cardiff.

Bringing together researchers, clinicians, nurses, policy makers and patients, this conference aimed to promote the excellent research being conducted in Wales and to highlight issues relating to policy-making, resources and services for people affected by cancer in the principality. All very laudable.

However, this put me in mind of more basic concerns I hold about how our supposedly national health service operates on the ground when dealing with such as cancer.

My background is in senior management and my area of interest and study has always been in the organisational issues that surround how things get done.

I accept my observations of our health service are limited, but of late my parents and I have spent a lot of hours in health service organisations.

I have been particularly struck by the lack of organisational joining up that is present throughout my experiences.

In cancer treatment this seems to me almost criminal.

By the very nature of cancer it will move from organ to organ and body system to body system, but we organise specialist diagnosis and treatment under the baronies of consultants.

This seems to me to present organisational hurdles to the detriment of the patient and I believe leads to two certainties, inefficiency in treatment and the danger of less than the best treatment.

In 2002 my father was diagnosed with bladder cancer. This was treated by an excellent consultant urologist, who also tested to see if cancer had spread to my father’s kidneys – kidneys and bladder being under his remit.

Cancer was found in one kidney and, shortly after, one kidney was successfully removed. Soon after this my father complained of a lump on his left side.

The consultant urologist thought this likely to be due to having cut through muscle tissue in reaching the kidney.

Over the following three years my father’s GP accepted this theory, but by 2006 the lump had grown in size and my father had started to loose his appetite.

My father was then referred to another consultant who specialised in the bowels and the cause of the lump was found to be severe colon cancer. Three months later my father was dead.

Now, according to the World Health Organisation, colorectal cancer, also called colon cancer, is the third most common form of cancer and the second leading cause of cancer-related death in the Western world.

According to the WHO, colorectal cancer causes 655,000 deaths worldwide per year, including about 16,000 here in the UK, where it is the second most common site (after lung) to cause cancer death.

Where I stand on this is that organisational failure resulted in my father’s colon cancer not being found until it was too late.

In my view, even without the symptomatic lump, given his cancer history a colonoscopy should have been performed as soon as possible after the kidney operation as this is the only certain way to determine if cancer is present in the bowel. Had he been in the United States then this would almost certainly have be done.

The trouble with colon cancer is that it has no symptoms until it is very advanced.

My internet research suggests treatment at the early stages, however, is almost 100% successful. The reason why it is the second biggest cancer killer in the UK is because it goes undetected until it is too late.

In the US it is advised that every person over 50 should be checked every five years and that the children of those who have suffered colon cancer must be regularly checked as they are at greater risk.

I have paid to have my bowels checked and now will do so every five years!!

Looking at and reading the news about the wonderful new treatments and developments being discussed at the cancer conference saddened me, because I believe we are letting people die by not organising in a way that makes best use of what we already know.

If we can’t use the knowledge and resources we already have effectively to save lives now, what hope is there for new scientific discoveries?

Keith Dewhurst Lisvane, Cardiff

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