Cancer sufferers could die earlier if hospitals reduce patients’ access to chemotherapy because they have too few nurses to administer it, cancer charities fear.
Their warning came after a leaked memo revealed that a leading NHS cancer centre may have to make patients wait longer to start chemotherapy or cut the amount of drugs they receive because it has huge staffing problems.
Macmillan Cancer Support said the prospect of the Churchill hospital in Oxford in effect rationing life-extending and potentially life-saving chemotherapy was alarming and could deny the dying “precious time” with their loved ones.
“A group who may be particularly affected by such a decision would be those who have treatable but not curable cancer,” said Dr Karen Roberts, Macmillan’s chief nursing officer.
“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.”
The possible limiting of vital cancer care in this way is thought to be unprecedented. It is set out in an email from Dr Andrew Weaver, a consultant oncologist and the Oxford hospital’s chemotherapy lead, to fellow cancer specialists there.
Weaver, who sent the memo on 3 January, identified a 40% shortfall in the number of specialist cancer nurses as the key cause of “difficulties” its day treatment unit (DTU) is having giving rising numbers of cancer patients chemotherapy quickly enough.
Limiting access to it 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 planned: 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.
However, in future dying patients could receive less chemotherapy as a direct 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.”
Sir Harpal Singh Kumar, the chief executive of Cancer Research UK, warned that more hospitals may do the same as the Churchill unless ministers urgently tackled big holes in the NHS’s cancer workforce.
“It’s totally unacceptable that these shortages could lead to delays in patients getting cancer treatment. Immediate action needs to be taken by the government to deal with this, otherwise problems like the one at Oxford will become more widespread and more severe.”
Oxford Universty hospitals NHS trust, which runs the Churchill, said it had not decided to implement any of the 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 at 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?”