Choice of hospital can halve chance of surviving cancer

CANCER patients treated at a Glasgow hospital are twice as likely to die as those cared for at other units just five miles away but senior doctors claim managers have failed to tackle the poor survival rates for fear of causing a political row, a Sunday Herald investigation has found.

New statistics, shared with the Sunday Herald, reveal that around 11% of lung cancer patients attending Glasgow Royal Infirmary and the Western Infirmary in Glasgow will be alive after three years, while only 6% of patients at Stobhill Hospital in the north of the city will survive the same period.

All three hospitals are part of the same NHS trust. Managers are aware of the variations but they have been kept hidden from patients.

One senior cancer doctor said: "You are twice as likely to be alive after three years if you are treated at Glasgow Western Infirmary or Glasgow Royal Infirmary than at Stobhill Hospital. That is well known to a good number of people.

"Management are aware that if you get treatment for lung cancer in one hospital you are half as likely to be alive after three years as if you are being treated in two other hospitals in the trust. These statistics are available but nothing is being done because of politics."

The doctor compared the situation to the Bristol babies heart- surgery scandal. Up to 35 babies operated on at Bristol Royal Infirmary are estimated to have died unnecessarily due to poor performance. A report into the scandal found that surgeons were able to cover up high death rates by claiming they were on a "learning curve" - and their powerful positions both on the wards and at management level meant nobody was able to question them.

The lung cancer data was gathered by the Glasgow managed clinical network for lung cancer. Managed clinical networks are the system through which care for conditions like cancer is shared between specialists at major teaching hospitals and local doctors, giving patients the benefit of local access for day-to-day care and specialised attention.

Rivalries between medical professionals have been blamed for the variations in lung cancer survival rate.

Numerous studies, including one published this month in the British Journal of Cancer, show that patients are more likely to get treatment, and to survive if they are treated by an oncologist, a cancer specialist.

The British Journal of Cancer paper said: "There is geographical inequality in the treatment given to lung cancer patients and patient survival. There was evidence to suggest that these inequalities might be explained by variation in access to oncology services."

But oncologists claim other specialists, including chest physicians and surgeons, are reluctant to refer cancer patients to them for expert advice. They say these doctors insist on caring for their patients, even if they have limited training in cancer treatment. The oncologists point out that many patients have no idea whether they are being treated by a cancer specialist or not.

Guidelines issued by the Royal College of Radiologists in 1996 stated that "chemotherapy should be initiated and supervised by accredited and experienced consultant medical and clinical oncologists".

But a survey conducted by the Sunday Herald has found that in many hospitals across Scotland surgeons and chest physicians decide how cancer patients should be treated and supervise their chemotherapy.

Although most hospitals say patients receive input from managed clinical networks, which include oncologists, doctors say the level of input varies enormously. They claim territorial battles between medical professionals prevent consultants from referring patients to cancer experts.

"Managers at North Glasgow University Hospitals NHS Trust are aware of concerns about the degree of expert supervision in different hospitals within the trust," the senior cancer doctor said.

"Lung cancer is the main area in the UK where oncologists are not fully involved with all patients all of the time. That is because of political rivalries. Chest doctors don't want to lose the leading role. They feel like they are losing control. Chest doctors are not trained in oncology. They are not fully trained to give chemotherapy. There are a number of chest physicians in the West of Scotland giving chemotherapy with minimal input from oncologists.

"Figures were worst where cancer care was not provided by an oncologist. The treatment the patients receive is not cutting edge. We are in a pre-Bristol situation."

Patients attending Stobhill Hospital would have a greater chance of survival if they were referred to the Beatson Oncology Centre at Glasgow Western Infirmary or to oncologists at Glasgow Royal Infirmary just five miles away. But, according to doctors, this has not been backed by managers for fear of provoking allegations from politicians of running down Stobhill Hospital. A retired GP is standing in the Scottish elections on the single issue of opposing plans to downgrade Stobhill Hospital to an Ambulatory Care and Diagnostic centre (ACAD), with no casualty unit or overnight beds.

Last year the Sunday Herald revealed that your chances of being treated for lung cancer and your chances of survival after five years vary widely depending on where you live. Scottish Executive figures showed that if you live in Grampian, you are 160% more likely to get treatment than if you live in the Ayrshire and Arran health board area.

The most recent statistics, from 1997-98, show that only 48% of those diagnosed in Ayrshire and Arran get surgery, radiotherapy or chemotherapy treatment. In Grampian, there is a 68% chance of getting one of the three alternatives. The Scottish average was 56.5%.

Of those diagnosed with lung cancer, survival rates beyond five years are very low, but they vary widely. Those who live in Grampian have a 9.8% survival rate, while in Ayrshire and Arran it is 5.1%.

Experts say the variation is due to patients in Grampian being more likely to be treated by an oncologist.

Professor Gordon McVie, Director of Cancer Intelligence and former Director General of the Cancer Research Campaign, says patients should ask whether their doctor has been trained in treating cancer.

"There is a clear correlation between whether a patient is treated by an oncologist and survival.

"Where there are differences in survival the clinician should be questioned. This doctor should be asked why, within the same area, other doctors are producing better results. It is up to them to explain.

"If the only explanation for this data is that some rivalry is getting in the way of patient care, then hospital managers ought to intervene."

He said there are not enough oncologists to treat all cancer patients but they should have some input into treatment.

A spokesman for North Glasgow University Hospitals NHS Trust said: "We are aware that there is a managed clinical network set up for lung cancer and that it is beginning to compare data.

"We are addressing the data to make sure it is accurate and are working to standardise the approach across the three hospital sites. We have input [from oncology] into all three hospitals. It may vary due to the historical situation."

He added that the variation could be due to more deprived patients attending Stobhill Hospital. But doctors say levels of deprivation are similar between patients at Glasgow Royal Infirmary and Stobhill.

The trust could not say whether the figures will be made public.

A spokeswoman for Ayrshire and Arran health board denied that the treatment of patients by doctors who are not cancer specialists is responsible for the area's poor survival rate.

Additional reporting by Brian Lee Context Lung cancer survival rates vary widely. Reports show that a patient's chance of survival is greater if they are treated by a specialist cancer doctor. But senior clinicians claim politics prevent patients from getting the best care.

Copyright 2003 SMG Sunday Newspapers Ltd.
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