Euthanasia puts cancer care in the spotlight

CHANGES in palliative care should be accelerated by today's euthanasia debate. Director of public health Dr David Jeffs believed that efforts to enhance care for advanced-cancer sufferers had been hampered by the disparate nature of those who supply the services.

But he believed the death-with-dignity debate had focused attention on palliative care and would lead to greater action in the near future.

'The debate has really focused the attention onto palliative care,' said Dr Jeffs.

In June 2001 a Guernsey Cancer Strategy was developed, with 29 recommendations. A review in June showed that 10 had been achieved and significant progress was being made towards 13 more of them.

'The main areas of underachievement had been in the field of palliative care. It is hoped that this will be addressed through the recommendations of the recent ?Death with Dignity? report,' said Dr Jeffs in his annual report.

'A number of people are involved in supplying the care such as Les Bourgs Hospice, the Guernsey Cheshire Home, nurses and GPs. If it is just the Health and Social Services Department, then it is much easier to act quickly on an issue. Palliative care involves many different elements and they have to be involved so it takes a joint effort to bring about change.'

Dr Jeffs said that if the outcome of the euthanasia debate was a change in the law to legalise doctor-assisted death, then the role of palliative care could dramatically change, with possibly less long-term care needed. Whichever way the debate concluded, long-term should be as good as the rest of cancer care.

Dr Jeffs' report showed that male cancer-mortality rates had dropped by 31% over the last decade and that female cancer deaths were down 44% in the same period.

The most common new male cancers were prostate, colorectal and then lung, while the most common killers were firstly lung, then colorectal and prostate. There has been a fall in incidence as well as mortality related to these three main cancers.

Among Guernsey women, the most common new cancers were breast, colorectal and then lung. The most common killers were lung, then breast and bowel. There has been a rise in the number of new breast cancer cases but a fall in the incidence of the others. There has been a steady decline over recent years in mortality from lung, breast and colorectal.

'In general these figures show that there is better protection, detection and treatment of cancer,' said Dr Jeffs.

'With lung cancer, if you give up smoking, you can dramatically reduce the risk of getting it. If you get lung cancer, treatment is far less effective than the actual method of prevention. With breast and bowel cancer, detection and treatment are far more important than prevention.

'Fifteen years ago, a woman with breast cancer died. Now, if she is diagnosed early and the right treatment is given, then she has a good chance of survival. These statistics show that while there is a higher incidence, fewer are dying. With bowel cancer, there has also been a decline in mortality but this has been less rapid.'

In his report, Dr Jeffs warned of the growing waiting times for local cancer patients to get treatment in Southampton. He said that because of clinical contacts and geographical links, it was likely that patients would continue to go to south-coast centres for the foreseeable future.

But he added that if the department felt waiting times and quality of service were not acceptable and that it was not getting value for money, then it could change hospitals. It had already done so for kidney-dialysis patients.