Written Answers - Paediatric Oncology Services.
Alan Shatter
Question:
204
Mr. Shatter
asked the
Minister for Health and Children
if he will publish in full the report of the National Cancer Forum regarding the future of the paediatric haematology unit in Tallaght hospital and the care of paediatric leukaemic patients.
[3166/99]
As part of the deliberations of the National Cancer Forum consideration of the current diagnostic and treatment services available for paediatric oncology were examined. Expert opinion was sought, including those from Our Lady's Hospital for Sick Children, Crumlin and the National Children's Hospital, Tallaght. On foot of the expert opinion available the National Cancer Forum made recommendations to my Department. These recommendations are contained in a letter to me from Professor James Fennelly, Chairperson, National Cancer Forum and I am circulating the text of the letter with this reply.
My Department has since written to the hospitals providing these services, notifying them of my decision to accept the forum's recommendations as contained in the letter. I have since emphasised that, contrary to certain reports, there is no question of closing the paediatric unit at Tallaght, or of scaling down its treatment services in any way. I have also met representatives of the group "CHILD", Children's Hospital in Leukaemia Drive, and explained the situation to them. I have emphasised that the implementation of this decision will require close collaboration between the hospitals concerned so as to ensure the best quality of service for patients, and I have welcomed the agreement of the three Dublin children's hospitals to put in place a mechanism for joint decision-making on major policy issues regarding acute hospital services for children. I am confident that these steps will help to ensure the continuing provision of quality care for children with cancer.
Following is the text of the letter from Professor Fennelly.
November 1998.
Mr. Brian Cowen T.D.
Minister for Health and Children
Hawkins House
Dublin 2.
Dear Minister
The National Cancer Forum has been considering the current diagnostic and treatment services available for paediatric oncology.
At its meeting of 25 March 1998 it heard a very useful presentation on the subject from Dr. Fin Breatnach, Consultant Paediatric Oncologist, Our Lady's Hospital, Crumlin. Following this the Irish Haematology Society expressed a wish to make a presentation on paediatric leukaemia to the Forum and Dr. Owen Smith, Consultant Paediatric Haematologist, National Children's Hospital, Tallaght, made a presentation on 23 September 1998, on behalf of the Society.
In considering the issue, the forum was very conscious of the need for high qualify services from the stage of diagnosis to all appropriate forms of treatment, as discussed in the National Cancer Strategy. The forum is also conscious of the EU recommendation (Ref. 1) that there should be one paediatric oncology unit per five million population in Europe. International recommendations (Ref. 2) also state that the treatment of solid tumours should not be separated from the treatment of leukamia and that a Paediatric Cancer Unit (PCU) should have on site the appropriate infrastructure of services, personnel and equipment (Ref. 3) to guarantee an optimum level of service for these patients. Taking these recommendations into consideration the forum considers it inappropriate to have two centres dealing with paediatric leukaemia in Dublin. The forum is of the opinion that there is one specialist paediatric oncology unit in Ireland, at Our Lady's Hospital for Sick Children, Crumlin, and that both solid tumours and acute leukaemias should be referred to this centre.
The forum has formed the view that all paediatric oncology cases should be referred to the specialist paediatric oncology unit at Our Lady's Hospital for Sick Children, Crumlin for initial diagnostic work-up and treatment planning. This does not mean that all cases would necessarily have to be treated there. However, given the level of specialised expertise required in dealing with paediatric oncology, the forum believes that every childhood case of cancer should be seen there initially for advice and referral on treatment. Subsequent treatment, including chemo therapy, could then be delivered in the child's most appropriate local hospital, on a clearly defined and agreed shared care basis, subject to proper supervision.
There exists a high level of expertise in this area and the forum recommends that the personnel involved in paediatric oncology would explore the potential of utilising their skills for optimum patient benefit. This would involve discussion between Our Lady's Hospital for Sick Children, Crumlin and the Adelaide and Meath Hospital, incorporating the National Children's Hospital, Tallaght with a view to seeking agreement on revised structuring of existing consultant posts in order to permit access to the paediatric oncology unit at Our Lady's Hospital for consultants who have special training and expertise in paediatric oncology.
I would be glad if you would consider transmitting this view to the relevant agencies, including hospitals and consultants who deal with childhood cancers.
Your sincerely
James J. Fennelly
Special Advisor on Cancer Services
Chairperson of National Cancer Forum
Ref.1EU Subcommittee on Paediatric Oncology
Ref.2EU Committee on Paediatric Oncology
SIOP Committee on Standards of Care and Training in Paediatric Oncology – Recommendations for the Organisation of a Paediatric Cancer Unit (PCU)
Ref.3American Academy of Paediatrics – Guidelines for Paediatric Cancer Paediatric 1997.
Standards of care for children with Leukaemia – RCP London
Resources and requirements of a UKCCSG Treatment Centre
Centralisation of treatment and survival rates for cancer – CA Stiller
Survival in childhood acute lymphocytic leukaemia: effect of protocol and place of treatment
Access to Quality care: A consensus statement of the American Federation of Clinical Oncologic Societies.
