Cancer services in Trinidad and Tobago are currently provided in a haphazard and fragmented way. For the current government, whether old or new, improving the delivery of safe and effective care to anyone diagnosed with a malignancy is undeniably an urgent priority.
In my view, the evolution of cancer services in this country has included using the existing resources, already stretched too thin, to manage this growing problem.
This may seem to be the most practical solution but ultimately disregards the fact that cancer management needs a more streamlined and structured approach with dedicated services.
After all, you cannot view cancer in the same way as other diseases. All aspects of cancer management, from recognising suspicious symptoms to providing treatment based on current accepted evidence, require an urgency and expertise that should not be compromised.
The decisions made and actions taken can affect someone’s life and should not be done lightly. Using accepted guidelines to meet a certain standard can, without a doubt, improve outcomes.
Here are five strategies needed for the next five years that have the ability to transform the face of cancer management in the public health sector of this country.
1. Screening—as with any disease, prevention is always better than cure, and this is the underlying principle for cancer screening. Screening essentially means testing large groups of the population, most of whom have no symptoms of cancer. It aims to identify early signs, or indeed pre-cancerous lesions that can then be promptly treated before they progress further. We now need standardised national screening programmes for cervical, breast and colo-rectal cancers. Pap smears, mammograms and colonoscopies need to be more than just an after-thought, but a routine occurrence duly monitored and documented. Cancer screening has been shown to be one of the most impactful cancer control strategies that can save countless lives.
2. Establish cancer pathways—this is the patient’s journey from the initial suspicion of cancer right through to investigations, diagnosis, and treatment. Currently, many people are made to wait too long see a specialist, too long to have various tests and scans done, too long for results and too long to start treatment. Having standardised waiting times for those with suspicious symptoms and those with a proven cancer ensure that this group of patients need not join the same queue as those with non-cancer related illnesses. Even something as simple as having reserved time slots every day for cancer patients to have CTs or MRIs will mean that you don’t have the same wait as someone having a scan for uterine fibroids or gallstones.
3. Specialist training and expertise—it is no surprise that people who see a doctor with specific training to deal with cancer actually have a better outcome. Studies have clearly shown that patients with cancer who are managed in dedicated cancer centres by specialist oncologists have improved survival. We may not have a centralised dedicated cancer centre in Trinidad and Tobago, but we need to ensure that the right people with the right skills are the ones who are making the decisions.
4. Use of audit and clinical research—we will not be able to progress and improve our cancer care unless we are able to have an accurate picture of our own cancer prevalence, our incidence of new cases, our cancer mortality rates, and regular audit of our own practices to ensure certain standards are met. Using clinical research to also assess how we manage cancer in our local setting can guide us in the right direction and make us more attractive for international drug trials and experimental studies.
5. Palliative care—for those patients who require end of life care, providing the support for this is crucial. In addition to pain control and help for other symptoms, patients and their relatives require support, counselling and even the availability of hospice facilities is a fundamental requirement for a terminal illness. Providing a structured palliative care network with the necessary expertise from consultants to trained nurses to counsellors, has the ability to relieve significant health-related suffering.
People who are diagnosed with a malignancy are already anxious and concerned. They should not have to worry about whether they will receive a satisfactory level of care that is delivered promptly and efficiently.
It is now crucial that we focus on cancer management in a more proficient and streamlined way. In the midst of a global pandemic, we cannot allow these issues to be side-lined. This remains an urgent priority that must not wait for another five years.