Oncology Rounds

Ireland's government failed its women. Here are 3 ways to do better.

by Sarah Adam and Deirdre Saulet

If you have an eye on European health care news, you may have heard about the controversy surrounding cervical cancer screening in Ireland. Since 2008, the Irish public health service—called the Health Service Executive, or HSE—outsourced lab testing for cervical cancer screenings to a Texas-based lab. In recent weeks, the country has learned that the HSE had agreed to lower accuracy testing with the U.S. lab, using manual examination without the use of computer-based imaging that is standard in the United States. As a result, there have been several hundred false negatives and 17 patients have died.

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Beyond the obvious horrific impact on patients, the breakdown in the system has resulted in litigation, political scandal, and a decline in public confidence in the HSE. Already, the head of the HSE has resigned, and the U.S. lab has agreed to a $2.5 million settlement with one patient, who currently has stage 4 cervical cancer.

What can cancer programs learn from this?

While this situation is a unique—and certainly an extreme—example, it still highlights three key lessons for cancer programs when it comes to improving early detection of cancer:   

1. Vet your partners carefully

Cancer program leaders can avoid unwelcome surprises from external lab partners by proper vetting. In particular, as genomic testing expands, cancer programs should set clear quality standards by establishing assurance processes, tracking performance on specific metrics, and continuously evaluating the benefits of partnership.

There are several key factors you should consider when vetting potential partners—both at the outset of a partnership and continuously through the life of the partnership—including:

  • Breadth of testing options;
  • Quality assurance processes;
  • Accuracy of results/diagnoses;
  • Turnaround times;
  • Interpretation support for providers and patients;
  • Operational flexibility; and
  • Patient and provider satisfaction.

2. Leverage telehealth to expand access to expertise

Beyond pathology, organizations can maintain quality standards and reduce the risk of misdiagnosis by extending access to gynecologic oncology expertise via telemedicine.

For example, the University of Virginia (UVA) offers monthly telemedicine clinics in a rural area in Virginia that aim to improve cervical screening for high-risk women with abnormal Pap tests. Onsite nurse practitioners conduct the colposcopy while a UVA gynecologic oncologist oversees and instructs the biopsy using a camera attached to the colposcope. This assessment is also an opportunity for the patient to receive education about risk factors.

3. Engage in community education

Education is an effective way cancer program leaders can help prevent late-stage cancer diagnoses.

For instance, Upstate Cancer Center in Syracuse, New York, engaged the community by launching an advocacy campaign within schools about awareness and prevention for head and neck cancer caused by the human papillomavirus (HPV). Building relationships with PCPs in your network can lead to improved coordination and education on diagnostic testing, increased rates of vaccination, and improved patient awareness through education about the early signs and risks of cancer.

 

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