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Prostate cancer patients face wildly varying wait times

Categories: Medical

Some prostate cancer patients around the country are waiting up to four or five months for surgery, according to official information.

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Official information from 14 of 20 DHBs shows that prostate cancer patients nationwide face wildly varying wait times, with some district health boards (DHBs) struggling to find surgeons.

The longest wait was at the Southern DHB with 191 days, while the next longest appears to be Nelson-Marlborough DHB, with a 146-day wait for one patient.

RNZ asked DHBs for details of prostate cancer surgical waiting lists – including the longest wait time, the average wait time, and whether the DHB was meeting targets – following an investigation by Checkpoint with John Campbell into Dunedin Hospital’s urology department.

Some DHBs have not replied to RNZ.

National targets set by the Ministry of Health are 31 days from the decision to treat to treatment for those with a confirmed diagnosis, and 62 days from decision to treat to first treatment for those with suspected cancer.

A low risk diagnosis means a patient could wait up to 120 days.

Prostate cancer is one of the biggest cancer risks for Kiwi men, killing at least one man every day on average, with one new diagnosis every three hours.

Prostate Cancer Foundation chief executive Graeme Woodside.

Prostate Cancer Foundation chief executive Graeme Woodside said one of the main concerns was national inconsistency.

“The way men are treated, the different sorts of treatment that are available, or not available in different places, but also the huge variation in timeframes that people have to wait.

“We think that that’s not good enough. We think the DHBs should become more consistent.”

Mr Woodside said it was not clear whether it was resourcing at DHB level or prioritising that caused variation in wait times.

North Island

Across the North Island, wait times range from zero days (some DHBs do not have any patients on a urology waiting list) to 92 at Capital and Coast DHB.

Waitemata DHB said average waiting times were not useful as “we do not combine all prostate cancer patients together … patients will wait between 31 days and 120 days.”

DHBs use staged targets depending on the severity of cancer, or suspected cancer.

Surgeons, some DHBs said, often preferred to wait for six weeks from biopsy then perform surgery. This is to let any inflammation caused by a biopsy to settle.

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The longest wait in the Wellington region was 92 days. Photo: RNZ

At Capital and Coast, 18 patients were on the waiting list. The longest wait was 92 days, official information said, and that patient was booked for surgery on 5 September.

According to the DHB, which covers the Wellington region including the Hutt Valley, 90 percent of patients were treated within a 62-day target window “as per the faster cancer treatment (FCT) guidelines”.

“We do not have the surgeon capacity to achieve all prostate surgeries including [less aggressive, lower risk surgery], within 31 days from the decision to treat.

“There is not an agreement nationally around whether all prostate cancer patients benefit by receiving treatment within the FCT target timeframe.”

The FCT target was introduced in 2014 by the Ministry of Health with the aim of reducing waiting times.

The DHB said it was outsourcing some urology procedures to a private provider and recruiting an additional urology surgeon, according to documents.

At Auckland DHB, nine patients were waiting, the longest for 58 days. Counties Manukau has 41 patients with benign disease, none with cancer.

Taranaki DHB service director Leigh Cleland said one patient was waiting for surgery, the longest wait was 73 days, and the target for treatment was 12 weeks.

The DHB recently appointed a permanent urologist.

In Northland, two patients were waiting for treatment, the average wait was 50 days, and surgeons aimed to perform urgent surgery within 4 weeks, “semi-urgent” within 8 weeks, and routine surgery within 4 months.

Board chief executive Dr Nick Chamberlain said there were too few urologists.

“Specialised urologists are in short supply.

“Theatre access may be compromised by acute/urgent cases requiring immediate surgical intervention taking priority.”

South Island

In the South Island, the Southern DHB has been in the headlines. In July, Checkpoint revealed 10 prostate cancer patients at Dunedin Hospital waited up to seven months for surgery, which was meant to be happen within a month.

Dunedin Hospital.

The urology department in Dunedin Hospital was the subject of a critical review recently. Photo: RNZ

The DHB ordered a review, which described a chaotic, dysfunctional department in need of change.

Its chief executive agreed with the highly critical report, saying patient health and well-being were being placed at risk.]

Nelson-Marlborough DHB appears to have the second-longest waiting list. Its chief executive Peter Bramley said seven men were awaiting surgery (as at 1 August), the longest wait for a current patient was 146 days and the average wait was 46 days.

“Our goal is to get most patients into surgery within 60 days. For patients who have been assessed as being greater at risk, this is 30 days.

“While there is one patient outside of our treatment timeframe, we are meeting the target for all others.”

At the West Coast DHB, there was one patient on a list and the average wait time was between 4 and 8 weeks.

“Once a patient has decided and accepted a specific course of treatment, they generally receive that surgery within four to eight weeks,” it said.

Story by John Edens on Radio New Zealand