CANCER CARE IN CRISIS

Patients dying while waiting for treatment

A Johannesburg woman with late-stage breast cancer has told of her nightmare experience trying to get treatment from the state, including having to wait five months for chemotherapy due to broken machines and staff repeatedly losing her file.

After being shunted between Chris Hani Baragwanath and Charlotte Maxeke Johannesburg Academic hospitals, she finally completed her chemo course, but has now endured a five-month wait for a crucial scan to find out if the treatment has worked.

Her appointments have been cancelled twice because of broken machines, and again this month because there was no ink and paper to do the scan. Exhausted and ill, she is desperately hoping her next appointment, scheduled for next month, will go ahead so she knows if the cancer has spread.

The 66-year-old woman’s wait for news of her fate comes as a study by Cancer Alliance into backlogs of people waiting for cancer treatment revealed Baragwanath does not have a list of who among its 53 breast cancer patients is waiting for radiation.

A Sunday Times report in December revealed that two new cancer-treatment machines worth more than R100m, ordered more than a year ago, have been in storage since November.

The Linear Accelerator (Linac) machines, which deliver high-energy X-rays or electrons to destroy cancer cells while sparing the surrounding tissue, need to be housed in protective bunkers that haven’t been built.

The Gauteng health department this week said construction of the bunkers would begin next month and would be finished by the end of November. It said a task team is being set up to look at the issue of backlogs.

Charlotte Maxeke is Gauteng’s main oncology hospital, but it has been outsourcing some treatments to surrounding hospitals after a devastating fire.

The Cancer Alliance research, done by a medical consultant with the help of doctors at Charlotte Maxeke, focused on the four major cancers affected by the backlog — prostate, breast, cervical and colorectal — and examined all patient file records in February.

The prostate unit records listed 2,087 patients, of which only 819 could be accounted for. Of these, 343 were high-risk patients.

Of the 334 breast cancer patients at Charlotte Maxeke, 51 had been expedited, 123 were awaiting results, 17 were waiting to be called and 13 were recurrences. The rest were categorised as “miscellaneous” and “planning”.

The research report recommended that medical staff receive training in data management and that a “living” document be created where patients’ treatments can be updated and monitored. It also recommended that a checklist be added to patients’ files showing whether the necessary steps had been taken before radiotherapy, such as blood tests, X-rays and scans.

Louise Turner, COO of the Breast Health Foundation, said overly long delays in patients receiving radiation after completing chemotherapy resulted in some having to redo the chemo, or experiencing a recurrence of the cancer.

“Ideally a patient needs to start radiation within three months of chemotherapy. So when a patient starts chemo they are automatically given a booking for radiation, so they feel happy.

“But the problem is that booking is just for the first consultation after which they get sent home and told to wait for a call to inform them when they can start radiation. And that can take a very long time.”

Turner told the story of a 40-year-old woman from Limpopo who was diagnosed with breast cancer in January 2018. She was taken to Gauteng, where she had two surgeries, eight cycles of chemotherapy and 16 months of treatment.

She waited months for radiation, during which time the cancer returned. She was given second-line chemotherapy and underwent more surgeries. Her second round of radiation was delayed for five months by Covid-19 and the prioritising of other “urgent” patients ahead of her.

“By the time she got her radiation the cancer had metastasised into her lungs,” Turner said. She was buried on January 29.

Cancer Alliance’s Salomé Meyer there had been a crisis for at least five years. The alliance represents 33 non-profit organisations and cancer advocates.

“Cancer incidence is on the increase nationally. Most patients in the public sector are diagnosed with late-stage disease that requires more complex treatments,” Meyer said. “The increase in the number of diagnosed cancer patients, however, does not come with an increase in the budget to accommodate new equipment and more appropriate health-care professionals. The ideal is to treat patients within three months of diagnosis.

“At Charlotte Maxeke the equipment and health-care professionals are not adequate to treat timeously the number of patients requiring treatment. This means that the patient demands far exceed the supply of treatment equipment time and oncology professionals.

“This has resulted in a backlog of several years. Covid-19 and the recent fire at Charlotte Maxeke have further pressurised an already stressed oncology service, negatively affecting treatment outcomes for patients.”

The 66-year-old patient who does not want to be identified as she waits in limbo for her prognosis was diagnosed with latestage breast cancer in October 2020.

“Each time she went to hospital she would photograph her file and send it to me so we could keep our own independent record to recreate her history because information and her file went missing so many times,” said the patient’s daughter, explaining that her mother felt too overwhelmed to speak for herself.

“It’s not just my mom going through this. There are many other patients experiencing the same thing. The other day she was in a queue with another woman who also couldn’t be helped that day. That woman

So many of our comrades have been diagnosed with cancer and have not been able to get the help they need Sibongile Tshabalala

Treatment Action Campaign chair

was told to just come back the next day — but she didn’t have the taxi fare and nobody cared,” the daughter said.

Earlier this month, Cancer Alliance shared the results of its research with acting deputy director-general of health Dr Freddy Kgongwana and several other Gauteng health officials, at a meeting where it was decided that a task team would be set up.

Health department spokesperson Kwara Kekana told the Sunday Times the task team is expected to start work on April 1.

“The terms of reference will be established by the task team. We are waiting for feedback on the appointments,” she said.

Kekana said while new radiation machines have been commissioned in some facilities, they cannot all be used because of “inadequate staff components”, so machines are being used on a rotational basis.

She said the cancer-treatment machines worth more than R100m procured for George Mukhari and Steve Biko hospitals should be installed by the end of the year. Protective bunkers needed for the Linac machines will be built by the end of November.

In November last year, Cancer Alliance, along with other civil society organisations such as Treatment Action Campaign, Section 27 and People’s Health Movement, held a protest march to the office of the Gauteng premier.

A memorandum was handed to health MEC Nomathemba Mokgethi, asking her to take action by World Cancer Day on February 4.

Treatment Action Campaign chair Sibongile Tshabalala said the health-care system is broken.

“We are in the hands of bureaucracy. It has taken four months to get to this point where they are still putting a task team in place. Four months is a long time for a cancer patient. Four months of people waiting and, in some cases, dying.

“So many of our comrades have been diagnosed with cancer and have not been able to get the help they need. So that is why we are part of this partnership.”