‘Not manageable’: Patients waiting up to a year for cancer diagnoses at Sydney hospital

A woman who waited 139 days to discover a tumour taking up one-third of her bowel and another diagnosed with stage 4 colorectal cancer almost a year after her first referral are among cases which have caused doctors at one of Sydney’s biggest hospitals to sound the alarm on their dysfunctional department.

At least 21 patients have had to wait up to 363 days for a cancer diagnosis due to massive demand for endoscopies at Westmead Hospital, doctors said in a letter sent to hospital management on Thursday.

Two cases of delayed cancer diagnosis reported to Westmead Hospital management.Credit: Monique Westermann

The letter warned these cases, which included a man in his 60s diagnosed with oesophageal cancer 252 days after his first referral, were “likely a significant underestimation of the problem” because thousands of patients were waiting longer than recommended for the procedure.

There were 3356 patients on the endoscopy waitlist at Westmead as of last month, about half of which were “category 1” cases needing the procedure within 30 days. About 2500 patients did not have a date for their procedure.

The average wait time for those eventually diagnosed with cancer was 178 days, ranging from 47 to 363 days, the doctors said.

No patient had their cancer diagnosed within the 30 days recommended by the National Bowel Cancer Screening Program, and many exceeded the 120-day maximum wait time recommended by the Cancer Council.

“The significant delays are largely because Westmead has significantly fewer anaesthetic lists than equivalent-size peer hospitals,” the letter said. “Delayed cancer diagnoses are now a regular occurrence which is devastating for patients and demoralising for staff.”

Jeremy Chapman, a retired former director of renal medicine at Westmead, said it was concerning that so many patients were having their cancer diagnosis delayed.

“I’m sure anyone in the public hospital system would be shocked by those numbers,” he said.

Chapman said the National Bowel Cancer Screening Program, introduced in 2006 and now offering free tests to 50-74 year-olds, had helped improve cancer outcomes through early detection, but had also greatly increased demand on public hospital endoscopy services.

Cases reported to Westmead Hospital management:

• A 79-year-old woman waited 139 days to discover a tumour taking up one-third of her bowel. She was referred for surgery. 
• A 64-year-old man was diagnosed with oesophageal cancer 252 days after his first referral with weight loss and difficulty swallowing. He was referred for endoscopic resection but may still require chemotherapy or surgery. 
• A 74-year-old woman was diagnosed with stage 4 colorectal cancer after 363 days. She is undergoing neoadjuvant chemotherapy. 

Hospitals across the country have grappled with the increased demand, but Chapman said the impact had been particularly pronounced in western Sydney because of a “mismatch” between its health funding and booming population growth.

About 2.5 per cent of patients who record a positive blood stool sample and have a subsequent endoscopy are found to have cancer, an analysis by the Australian Institute of Health and Welfare found.

Dr Jenny King, the head of urogynaecology and deputy chair of the Medical Staff Council at Westmead, said this meant there could be hundreds of people on the waitlist who have cancer, but don’t know it yet.

“In a few months, they could have metastatic disease that is not manageable,” she said.

Doctors inside the department have repeatedly raised concerns with hospital bosses about the risk of patient care being impacted by long waitlists.

Leaked internal correspondence between doctors and management shows Western Sydney Local Health District chief executive Graeme Loy has been aware of the issue of endoscopy waitlists since at least 2019.

In the Thursday letter, the doctors said the issue has been flagged as “high risk” in the hospital’s electronic records system for years. They said they submitted a brief in 2021 highlighting a “supply and demand mismatch” and presented a plan for additional anaesthetic lists, nursing staff and administrative help.

The revelations emerged after Loy informed the head of Westmead’s gastroenterology department, Professor Jacob George, his leadership position would not be renewed.

King said the Medical Staff Council, made up of doctors from across the hospital’s department, would schedule a meeting next week to discuss the waitlist issue and the decision not to renew George’s position.

“We owe it to our colleagues and our patients,” she said.

Dr Fred Betros, Australian Medical Association NSW vice president and a general surgeon in western Sydney, said the issues in the gastroenterology department were another example of under-resourcing in NSW public hospitals – particularly in western Sydney.

“There is a clinical risk to a delayed diagnosis, and that’s my concern,” Betros said.

Health Minister Ryan Park said the reports were concerning and NSW Health was “urgently reviewing” the matter.

A spokesperson for Western Sydney Local Health District apologised to patients affected by the delays.

They said an independent review was under way to identify priority patients, and they expected patients with extended delays would receive appointments “over the next three months”.

“Patients will be contacted and provided an update and confirmation of their appointment,” they said. “We acknowledge how challenging it can be when patients have to wait longer than they expect to for a procedure.”

The health district has also set up a hotline for patients with concerns on 0439 148 391.

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