The decentralisation of facilities means long-distance travel should be less of an impediment, writes Muiris Houston
For years radiotherapy was centralised at St Luke's Hospital, Rathgar, Dublin, which provided an excellent service for people able to access it. While patients from Munster received treatment at Cork University Hospital, those from other far-flung corners of the State were forced to travel to Dublin.
For many people, already feeling drained after cancer surgery, it was a journey too far, so they simply went without. Some women with breast cancer from rural Ireland opted to have a full mastectomy rather than less radical surgery (lumpectomy) combined with radiotherapy.
Only 50 per cent of patients living in the former Western Health Board region had radiotherapy for breast cancer between 1994 and 1998. The rest, many with small children, simply could not face spending weeks in Dublin, miles away from their families.
It was this geographic inequity which has largely driven policy change in the area of cancer treatment. But both Mary Harney and her predecessor, Micheál Martin, also benefited from expert professional advice in formulating policy.
Prof Donal Hollywood, the Marie Curie Professor of Oncology at Trinity College Dublin, led a group of experts who published the landmark 2003 report Development of Radiation Oncology Services in Ireland. It recommended the establishment of a core spine of supraregional cancer centres - one each in Cork and Galway and two in Dublin. The experts stipulated that each centre should have a minimum of four linear accelerators (the machine that administers radiation to patients) in order to ensure a critical throughput that would bring with it guaranteed quality and improved patient outcome.
At stake was the need to ensure a multidisciplinary approach to cancer care that would deliver a potential 20 per cent reduction in cancer deaths.
However, the Hollywood recommendations met with sustained opposition from medical and public lobbies in the north-west, mid-west and south-east regions. They too were concerned with quality, albeit of a different sort. Relatives and patients wanted access to local radiotherapy units, especially for those people requiring palliative radiotherapy towards the end of a terminal illness and for whom long journeys are not an option.
So when Mary Harney announced her final decision on the future framework of radiotherapy last month, there were inevitably going to be winners and losers.
St James's Hospital is set to be the premier cancer treatment centre in the State. It will absorb St Luke's onto its campus and will have a total of 13 linear accelerators. Beaumont Hospital won out over the Mater and will service patients from north Dublin as well as parts of the north east and midlands.
There were no surprises in the arrangements for Cork and Galway. But Harney has agreed to two satellite treatment centres in Waterford and Limerick, much to the delight of regional lobby groups. The north-west is being asked to accept the promise of a future link with Belfast City hospital, subject to North-South negotiations.
Harney's plan promises a national network for radiation oncology services by 2011. With private finance, her goal is likely to meet its deadline. Patients here can finally expect multidisciplinary cancer treatment on par with the best available in Europe.