The National Cancer Control Programme (NCCP) was established in Ireland in 2007. Breast cancer surgery was centralised into 8 cancer centres for public patients in 2009, with referral guidelines, electronic referral and rapid access multidisciplinary teams, compared to 35 centres historically. The NCCP does not have responsibility for provision of private hospital services.
This study aimed to assess the efficacy and acceptability of the policy of centralisation of breast cancer surgery in Ireland.
Sequential explanatory mixed methods were chosen for this study
- Qualitative interviews with 28 randomly selected Family Doctors (GPs). Thematic analysis was carried out using Nvivo software matrices, according to attributes.
- Analysis of National Cancer Registry data for all patients diagnosed with breast cancer in Ireland pre (2008) and post (2010) centralisation (n= 4,633).
The majority of GPs referred their patients with suspected breast cancer to the specialist cancer centres in the public hospitals, regardless of private health insurance status. This preference for public hospital care was replicated for some other cancers but not for other diseases. GPs recommended breast cancer services in specialist cancer centres as an example for other health services in Ireland to adopt.
In 2010, following the centralisation of breast cancer surgery, 80.5% of patients had their breast cancer surgery carried out in a specialist cancer centre with multidisciplinary cancer services, compared to 51% in 2008 (p<0.001). The remaining surgery was carried out in private hospitals (19%), other acute hospitals (0.3%) or in another country (0.2%).
The policy of centralisation of breast cancer surgery in Ireland is endorsed by GPs and is providing multidisciplinary specialist care to the majority of patients diagnosed with breast cancer in Ireland.