22 Nov 2020

Bowel cancer screening programme needs greater coverage - Chris Jackson

9:48 am on 22 November 2020

The Cancer Society wants a better screening programme for bowel cancer to reduce the numbers of patients given a late diagnosis.

Dr Chris Jackson

Late stage diagnosis of several forms of cancer in Māori needs to be addressed, Dr Chris Jackson says. Photo: RNZ / Gareth Thomas

A Rotorua Hospital doctor is concerned a lot of people are being diagnosed with cancer at the emergency department, rather than through their GP.

The Cancer Society's medical director, Dr Chris Jackson, said though a bowel screening programme has been rolled out, half the country still lacks the proper testing methods.

He said patients diagnosed in hospitals' emergency departments usually had a "more extensive disease" at diagnosis, which could have worse outcomes.

Gut cancers, such as pancreatic cancer, had a high rate of emergency presentation, he said.

He said one reason Māori are more vulnerable to cancer than any other race is due to costly primary care.

"We know that Māori in general are diagnosed at a later stage than non-Māori again for many complex reasons, and we know that Māori for many cancers [are] diagnosed at a later stage for many cancer types and that is a very, very important issue that does need to be addressed."

Yesterday RNZ reported that a top doctor has found she has never had to diagnose so much cancer as she has in Rotorua Hospital's emergency department since starting there 18 months ago.

Dr Suzanne Moran's comments were made in a presentation to the Lakes District Health Board and followed the board's unusual step last week to call for people to only attend the emergency department (ED) if symptoms were urgent, stating the emergency department at Rotorua was "swamped".

Speaking to Local Democracy Reporting this week, Dr Moran - who previously worked in emergency medicine in the UK and worked for eight years in New Zealand - said people often didn't see chronic symptoms such as weight loss, changes in bowel habits or a smoker's cough as possible symptoms of cancer until its advanced stages, at which point they would go to the emergency department.

"So they don't realise, or sometimes it takes a whānau member to actually, kind of, say 'look, I'm really worried about you, we need to get you some help'."

Lakes DHB chief operating officer Alan Wilson said the percentage of people diagnosed in the emergency department as opposed to general practice was reported nationally and populations in poor or high deprivation areas - such as Lakes - tended to rate highly for diagnoses in emergency departments.

In some other communities, almost all cancer patients were diagnosed through their GP, he said.

Wilson said the key message for the community was to go early to GPs when symptoms arose and to participate in screening programmes.

Rotorua Aroha Mai Cancer Support Services founder and manager Bubsie Macfarlane said the underlying issues driving overstretched emergency departments - and the cancer diagnoses within them - were similar.

She said many poorer people, particularly Māori, were likely to put off going to their GP because they were "just trying to survive".

For some, it's a choice of going to the doctor or putting food on the table, she said.

Macfarlane knew a lot of people who caught their cancer later than they otherwise would have as a result.

"Then one day, they're so crook they end up in ED … because they don't have to pay."

Macfarlane said if screening programmes were more prominent that would help, as well as improvements in health promotion.

She said the health system needed to work with Māori more in order to increase the likelihood of earlier diagnoses.

"For Māori it's very personal when it comes to the body, and some doctors and nurses don't understand that. They don't have an understanding of how indigenous people accept things and what might be taboo.

"Unless you understand the culture, you can't understand the person."

She said Māori had to play a role as well: "Māori need to look after Māori".

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