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4. DIAGNOSIS AND TREATMENT
i GPs have a significant role to play in the early detection of cancer and patients are encouraged to contact them if they are concerned about possible symptoms. GPs are trained to recognise these symptoms (though this is not always easy) and refer patients for further specialist investigation. There are now a range of referral guidelines and protocols which are designed to ensure that the person is referred to the right specialist and receives the correct investigations in a timely fashion. Updated Scottish Referral Guidelines for People with a Suspicion of Cancer were issued in February 2007 ( NHSHDL(2007)9).
If cancer is diagnosed, there are many health service staff who are involved in caring for patients - the primary care team, the consultant surgeon, oncologist, specialist nurses, pathologists, radiologists, palliative care specialists, haematologists, pharmacists, allied healthcare professionals, administrative support staff and operational managers to name but a few. Modern healthcare is complex and relies on highly skilled people using the most up to date evidence and equipment to provide the best care possible for patients. We therefore need to support and develop innovative healthcare models which ultimately improve delivery of patient care, through early cancer detection, investigation, diagnosis and treatment.
Surgery is the most common form of treatment for most people with cancer, dependent on the type of cancer they have. Scotland has a highly trained and effective surgical workforce who are committed to continuous quality assurance and routinely audit their practice.
Chemotherapy involves the use of cytotoxic drugs to destroy cancer cells. Its use has expanded over time. The delivery of outreach services provided by specialist clinicians and the administration of chemotherapy by local doctors and nurses, offers an increasing number of patients the opportunity to receive treatment closer to home without the need to stay in hospital.
All chemotherapy services in Scotland - regardless of whether they are delivered locally or in a cancer centre - must meet the stringent standards set out in NHSHDL(2005)29. Only if these standards are demonstrably met is it possible for local hospital(s) or services to provide chemotherapy treatments.
Radiotherapy is a highly complex and specialised form of treatment for cancer. It may also be used to relieve some of the symptoms of cancer and it remains widely accepted that radiotherapy will continue to be an essential component of cancer treatment for many years to come. The Radiotherapy Activity Planning Report (2011-15) (2006) set out the current and projected needs for "external beam" therapy in Scotland and it is essential that we continue to work with experts to ensure that the planning assumptions used in this work are reviewed and updated regularly.
Radiotherapy can be given from outside the body by machines (linear accelerators) using beams targeted at the cancer. It can also be delivered internally (referred to as brachytherapy), using radioactive sources which are placed in the body close to the tumour site.
All 5 of Scotland's cancer centres are now equipped with state-of-the-art linear accelerators and related equipment, such as CT simulators and highly sophisticated treatment planning systems. The number of linear accelerators has increased from 21 in 2002 to 24. A further (25th) linear accelerator due to become available in Inverness by 2009, where building work is underway to create the additional space required to house that as well as a new CT simulator for treatment planning.
There is ongoing debate about how best to provide radiotherapy treatment as locally as possible while still maintaining specialist expertise required to deliver this treatment. Some of the treatments are highly specialised and require expert planning and delivery. However, other treatments are more straightforward and there may be further opportunities to evolve the organisation of radiotherapy to meet the projected increase in cancer cases and deliver treatments locally.
Recent incidents, both in Scotland (Scottish Executive, 2007) and in France (Inspection générale des affaires socials, 2007), have highlighted again the risks to patients undergoing radiotherapy treatment, and the vital importance of ensuring that treatments are planned and delivered with the utmost care. In this regard, the Scottish Government is continuing to work with the 5 radiotherapy centres in Scotland to further develop provisions for enhancement of patient safety.
Issues to Consider
- How do we continue to improve diagnostic and treatment services?
- How should we support the future development of surgical skills within NHSScotland's workforce?
- What are the future priorities to ensure safe and effective radiotherapy, chemotherapy and drug treatments across Scotland?
- What more can we do to ensure cancer genetics services are positioned to play their full part as technology develops and knowledge grows of the impact of genetics in prevention, diagnosis and treatment of cancer?
- How do we balance the need to ensure local access and convenience with the need to maintain specialist expertise and capacity?
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