Prof Tom Keane, Interim Director, HSE National Cancer Control Programme
Kings Inn House, 20 Parnell Street, Dublin 1
Tel: 01 828 7100

The HSE's National Cancer Control Programme is led by Professor Tom Keane as Interim Director, and is setting out the future of cancer treatment in Ireland. Implementation of the National Cancer Control Programme will involve the transfer of all major cancer treatment to the eight designated Specialist Cancer Centres. These centres will provide treatment for all forms of cancer, involving diagnostic, surgical, medical (systemic) and radiation oncology services.

The delivery of systemic therapy services (medical oncology/chemotherapy) will continue to be delivered at a number of agreed locations linked- under protocol - to the new centres. Patient support and palliative care services will also be provided at local level to ensure ease of access.

The National Cancer Strategy - A Strategy for Cancer Control in Ireland- published in 2006, recommended that Cancer Centres should be networked together in Managed Cancer Control Networks and there should be a broad aim of equipping each of the HSE's four regions with broad self sufficiency of services in relation to the more common forms of cancer.  

Specialist Cancer Centres will be located and networked within each of the four HSE administration regions. Successful Cancer Centre models internationally were examined as part of the process of designating the eight centres in this country.

Each of the newly designated centres are required to meet the following criteria:

• Each Specialist Cancer must serve a population of at least 500,000
• In the Irish context, each of the four HSE Regions should be required to have broad self sufficiency in respect of the most common cancers
• Each HSE Region will have two Cancer Centres in a Managed Cancer Control Network
• Rare and complex cancers should be treated by a subset of the eight cancer centres, consistent with evidence based practice and likely population incidence
• Centres will be designated for the treatment of rare and complex cancers based on an analysis of existing patterns of care and pre existing resources within the limitations of this criteria
• Cancer Centres must be well supported by general medical and surgical infrastructure (including all general consultation services, including pathology, lab-medicine and radiology/imaging as well as support services eg respiratory, physiotherapy, occupational therapy, rehabilitation, nutrition, palliative care)
• Cancer Centres will require availability of critical surgical subspecialty services to support cancer control activity
• Cancer Centres will require availability of medical oncology/systematic therapy support - consultation, therapy, curative and palliative therapies, clinical trials, etc.
• Host hospitals must be receptive to and have the capacity to sustain a multi-displinary team environment engaging health professionals across common clinical services and academic endeavours
• Cancer centres will require host hospitals with an academic environment - availability of university and/or technical education facilities for education and speciality training for health professions
• Cancer centres will require a research environment within the national network - availability of university facilities, research institutions and research infrastructure
  

On that basis, the following eight centres have been designated:

• Beaumont Hospital
• Mater Misericordiae Hospital
• St James's Hospital
• St Vincents University Hospital
• Cork University Hospital
• Waterford Regional Hospital
• University College Hospital, Galway (with some linkage to Letterkenny)
• Mid Western Regional Hospital Limerick

Linkage to Letterkenny:

There are particular and unique geographical circumstances applying to Donegal. This is reflected in north-south co-operation in the provision of radiotherapy from Belfast.

On a sole exception basis, the Managed Cancer Control Network in the West will therefore be permitted to enter into outreach service delivery in Letterkenny as an additional activity. This exception is subject to:

• The core case volumes at Galway meeting the minimum criteria (not taking into account any remote care caseload arising from this provision)
• All other QA (Quality Assurance) criteria being satisfied on the same basis as for care delivered in Galway
• Services to be provided by staff attached to the Galway Cancer Centre
• Integrated clinical governance provided by the Galway Centre
• Outreach activity, if undertaken, should be incorporated in rigorous process and outcome audit as though the activity took place at Galway to ensure that the provision of such an outreach service does not serve to place patients availing of it at any disadvantage compared with patients treated in Galway
• The potential to meet the needs of cancer patents in Donegal through North-South initiatives, such as the Belfast Radiation Oncology service, must be optimised and fully facilitated

Breast Cancer Services

There are currently around 2,000 cases of breast cancers in the public hospital system. However, it can be expected that BreastCheck, the National Breast Screening Programme, will reduce this number of symptomatic presentations over time by between 33% and 50%. Taking into account existing levels of activity in some larger centres and the minimum throughput (150 new cases per year) in the report of the Expert Group chaired by Professor Niall O'Higgins, this indicates that Ireland will require a maximum of eight centres.

 On that basis, it has been concluded that the treatment of symptomatic breast disease will be best delivered at all of the eight designated Specialist Cancer Centres.

 Transition of breast cancer services from the current settings will occur on a phased basis, with patients re assured that each transfer will be carried out in planned manner. Services will be withdrawn sequentially from hospitals which do not meet the defined criteria for delivery of symptomatic breast care, commencing with the lowest volume hospitals.

In September 2007, the HSE formally requested the following hospitals with low case volumes to no longer provide multi disciplinary symptomatic breast services and surgical treatment with immediate effect:

• Naas General Hospital
• Tullamore General Hospital
• St Columcille's Hospital, Loughlinstown
• Mallow General Hospital
• Louth County Hospital
• Cavan General Hospital
• Our Lady's Hospital, Navan
• Mid Western Regional Hospital, Nenagh
• Ennis General Hospital
• St Michael's Hospital, Dun Laoghaire
• Roscommon County Hospital
• Portiuncula Hospital
• Mercy University Hospital, Cork (Cytology and Histopathology services in association with SIVUH exempted)