Transcribe your podcast

The part Kenny show on news talk with Marter private network during current restrictions. Don't ignore your health concerns. Our expert team is ready to help. Now, the past year has been a difficult one for our health services as it struggled to cope with covid-19 and that struggle goes on. But there will be knock on impacts and will be fare any better in 2021, when in addition to everything we're doing at the moment, we have to add in a massive nationwide vaccination program.


Professor John Crown, consultant medical oncologist at St Vincent's Hospital, is on the line. John, good morning and a happy Christmas to you.


Good morning to you, partner. Happy Christmas. And I'd like to wish all your listeners a happy, peaceful Christmas in the difficult circumstances and a healthy New Year.


Now you are on one particular frontline, and that is the cancer diagnosis and treatment frontline. How have things been for you in 20/20, given that for the bulk of 2020 there's been a struggle with covid-19? Well, there's no doubt that it did cause quite a few changes, but I must say this was quite a bit of, I think, adaptability shown by the folks who worked in the front line, in the service, by the nurses, the doctors, et cetera.


And we really have managed to keep the show pretty much on the road. There certainly were compromises early on and we made some changes in our plan treatments for some patients through some treatments that you would say this has such a degree of marginal benefits and such a degree of risk. And we all calculated that, that in some cases the risk would be higher in a pandemic. And as a result, some treatments were not given or they were tailored or they would change to the schedules were changed.


We've made huge efforts to keep people out of hospital. There's no doubt that there have been some delayed diagnosis cases with cancer. Multiple reasons for this. Of course, the closure of screening programs didn't help, although it was not the principal contributor and there was a general decrease in access to diagnostic services because they were rechannel to covid requirements. And in addition, that was a factor that many patients themselves, I think, understandably, were very afraid of engaging with the health service.


So we've all commented on the fact that we've been very busy over the last quarter, calendar year, and I think that there was probably some pent up demand from people who were not presenting with problems earlier in the year and are doing so now. So we're all very nervous about the first quarter of next year, obviously were full of hope that the vaccines will help fix the problem. But we are facing into this next lockdown, not during a nice, fine spring, but during a cold winter with a high level of community transmission already established.


And this somewhat frightening possibility, although the degree of fright we should have is not yet well established about the new variant of the virus. So a little apprehension at the minute, but we are still trying to keep things going. We had a meeting this morning of our best multidisciplinary group, all virtual and nearly nobody physically present at the meeting. Oncologists, radiation oncologist, surgeon, specialist, breast cancer nurses, pathologists, radiologists. You know, we still run through 40 or 50 cases this morning planning their treatment for the next few weeks.


Now, the question of cancer treatment anyway. I mean, you were one of those who's been advocating for many more consomme consultant oncologist being necessary to provide a system worthy of the name where shy of those by, I don't know, dozens and dozens. Has any progress had been made on that front?


Well, I mean, if you're asking me to do kind of a long term report card over the last decade or two decades to have been very substantial improvements. I mean, the biggest improvement in cancer care in Ireland has been due to the international improvements and the availability of drugs. I was having this discussion with somebody from my family the other day trying to work out why everybody seems to be so busy in the oncology world now. And one reason, obviously, is the shortage of doctors and the desperate shortage of diagnostic facilities, the incredible rates that people have, especially in the public sector for scans.


But part of it is due to very good news. The treatment for cancer has gotten much better. And as a result, many patients with many relatively common kinds of cancer were in the past. We might have had an initial consultation with and imparted some fairly sad news about the limitations of treatments, perhaps tried some kind of old fashioned chemotherapy for three or four months. And if it didn't work, that would have another very sad shot saying really, there's no further active anti cancer treatment for you and we should, you know, entrusted to the very compassionate hands of the palliative and hospice care services for many of those patients.


We now have treatments for keeping them alive for two and three and four years and sometimes longer, and in some cases curing them. And as a result, when I see a new patient will say with malignant melanoma, a potentially very deadly form of skin cancer, I hasten to add, one that's usually cured if you just have the spot removed from your skin following an early diagnosis. But if you come to somebody like me or to my my colleague, Dr Power in Cork or Dr Kelly in the matter, you know, with an advanced secondary melanoma, what do we have to offer you now is every prospect of multiple years of survival, whereas in the past it was a few short months.


And so the actual number of doctor patient encounters per newly diagnosed cancer patient is much higher now than it was. This is wonderfully good news. I mean, it is. It's extraordinary. And I'm sixty three part. And I can tell you this all really changed by the decade, a decade and a half ago. And it sounds like a cliche to say this, but I'm so glad that I have lived to see such extraordinary improvement in the treatment of so many cancers.


And and actually, you know what? We're hearing some people now that things that are incurable before and not as many as I'd like, but we are hearing some people now. Hmm.


I'm sure some people will be dismayed by the news that you're 63 and thinking 65 will have no more reason to go to. Will you be able to go to 79?


Will be equaled by those. That'll be happy to see me go. I'd say possibly in hospital administration and the Department of Health and DHC. I suspect they might contribute, but the good or bad news, depending on your perspective on that particular thing, of course, is that I, amongst others, did kind of try when I was in the Senate to put on the agenda the insanity of our mandate of our numbers based mandatory retirement at 65. And that has now ended.


So I believe I will now be able to go until I'm 70, which is wonderful. If my health disparities spirit, I, you know, have a wonderful family. I have three older children. But I also have a five year old. So I'm very, very hopeful of my health. The spread that I'll continue working. I love what I do. I probably, to an unhealthy degree, have let it define who I am. And I'm probably, in some cases, the poster child for a really messed up work life balance.


But I would hope I would hope that my you know, especially in a situation where No. One, we can't afford the pension burden, we have No. Two, we're having problem replacing people because a lot of folks are not applying for consultant jobs. Number three, there's a desperate shortage all around. To me, it's it makes no sense whatsoever to force able bodied people who want to work to become dependents on the state. Does it?


It certainly does not. Now, John, next year we have the added challenge of the vaccination program. And there are already concerns that people will be taken off frontline duties to get people vaccinated. And it's always going to be a balance, isn't it? Because the more people we have vaccinated, then the more the covid-19 pandemic will diminish and therefore everything will come back to normal.


But there will be potentially, you know, shortages, casualties along the way because of that diversion of people. It is part it is, of course, inevitable that there is going to be administrative and public financial pain of a huge degree associated with this vaccine. Sorry, but this pandemic. But the responses to it, but the you know, in positions, it is made on people's lives and on the macro economy. But honestly, we need to do it.


I think we need to just grit our teeth and just give this the highest priority. I think it would be catastrophic for us if we find ourselves facing into like we're going to have our one year anniversary of our involvement with this, you know, relatively soon on about two months time, it would be catastrophic. I think, if we don't have it under control. I thought. Hello, are we there? Yeah. Yeah, we're listening to.


So I heard a few beeps, sir. It would be catastrophic, I think, if we do not have it under control by the one year anniversary and really try to get things back to normal, we will have a major financial hangover. The bill, and I'm sure you will probably be interviewing people like me next year who are complaining about the lack of access to new cancer treatments, to diagnostic services, to surgery for children with spinal deformities, to waiting lists for hips, etc.


, because there will be, you know, paying the bill for what we've had to do over the last year. But I must stress, it is it's very important that we give it a high priority. And honestly, people need to just take the vaccine. I mean, they really do. I will gladly roll my sleeves up the first day it's available to me. I really want to get it. I want my family to get it. We don't yet know what the rules will be about cancer patients, but I want my patients to get it.


And certainly all the staff there's been there's been a real problem with this pandemic with hospital acquired infections. I think everybody realizes that. And it's critically important that we vaccinate staff to stop them being potential vectors for transmission.


All right. Look, John, thank you very much for joining us. In the run up to Christmas, our medical oncologist at St Vincent's Hospital in Dublin, Professor John Crown. I wish you and yours a very, very happy Christmas. Thank you very much for joining us this morning.


Now, some of the texts coming in, I was already facing a Christmas without my two sisters who both live in the U.S. and can't come home. Then we had to cancel the annual dinner with extended family on Christmas Day. To just myself and my parents, it was already going to be our quietest, loneliest Christmas ever. And now with the new variant, we've just this morning cancelled our annual Christmas Eve lunch because we're all too worried about being in a restaurant.


Now, even with the best safety protocols, I just don't feel safe with this new variant moving around. I know this is all just the way it is. And I'm not saying we shouldn't have restrictions, but I feel so down, though. Every little bit of Christmas has been peeled away piece by piece by this wretched virus.


I think deep down we all keep looking at the horizon.


And I know that for me, for a long time, the horizon was Christmas. During the last six week lockdown, I kept telling myself this was all worth it to get to Christmas and to be free to meet friends and family, even with limitations. Now that is gone. And I just tell myself it's all about getting to the springtime. But how many times can we keep doing this? Another one. I have followed all health advice since March, only seen my over seventies parents five times since March.


It used to be weekly. At least my business is struggling, even with the so-called government help.


Another lockdown, which I will adhere to, but explain where the cases are rising and why. And don't just take the easy way of close everything. This Christmas is a write off. I'm sick of it, says Tony Graham, a double says. I went to a shopping centre in south of Dublin yesterday. So many people in the centre not wearing masks, little or no social distancing. We got so annoyed. We left before getting what we actually went to the centre to buy.


I actually felt foolish for thinking it would be better. These are the same people who complain about continued lockdowns but do nothing to help the spread, to stop the spread. They should be ashamed of themselves and we should help them to see that shame by calling it out to them. That's from Graeme in Dublin. And indeed, you know, the people who talk to me and text me and tell me that their mates coming in from the UK or whatever are all out on the town.


There's no point in telling me because I'm not going to name somebody that I don't know on air and publicly shame them. You've got to tell them yourself. You've got to say to them, you're a disgrace. Perhaps that's what you've got to do. How uplifting to hear Professor Crowd speak so optimistically about cancer treatments in a time of gloom, his considered and measured contributions are so welcome here. Thank you, John Crown from Louise in Dublin.