Doctors and advocates are warning there is a risk some people will fall between the gaps. Photo: A. BENOIST / BSIP
Manawatū residents at higher risk of developing bowel cancer have been told they will not get their regular check-up colonoscopies for at least six months.
Te Whatu Ora MidCentral said it was prioritising patients with symptoms and those in the National Bowel Screening programme - but doctors and advocates are warning there is a risk some people will fall between the gaps.
The letter to one patient said MidCentral's endoscopy service was "pausing" surveillance colonoscopy, due to increasing demand with National Bowel Screening and urgent referrals.
"The change is made to give us the best chance of being able to perform timely colonoscopy for symptomatic patients, and for patients participating in the bowel screening programme."
Some people will fall through gaps in bowel screening - doctors
The patient, who shared the letter on an online forum, was supposed to have annual colonoscopies due to polyps found previously, some of which showed precancerous growth.
"I am lucky in that I was diagnosed young and so with regular surveillance I should avoid getting bowel cancer, something I almost certainly would have got by my mid 30s had I not been under regular surveillance," the patient wrote. "I am already a few months overdue, and by the time this resumes (at the earliest), it will be closer to a year, twice the interval recommended."
Not too young to get bowel cancer
A bowel cancer survivor from another region said he was shocked at what was happening in MidCentral.
Jason Bavage - who lived in Tauranga - thought he was too young to get bowel cancer. So did his GP.
When he first went to the doctor with his symptoms (after sitting on them for several months), his doctor said it was probably haemorrhoids or irritable bowel syndrome, and suggested he change his diet.
However, the symptoms just got worse, so he returned to the GP, who agreed to refer him for a colonoscopy - but warned it was likely to be declined.
"He said, 'I'll try and refer you for a colonoscopy but you're not likely to be accepted - basically you're too young and there's no family history. But we'll see what we can do.'"
Bavage's symptoms got worse - he was waking several times a night and spending hours on the toilet. His GP gave his referral another push and he was told he should get an appointment within three months.
However, as the weeks went past, he heard nothing and no one could give him an update on what was happening.
Bavage's father sat him down and told him they were "going private".
"I was worried about money, and I was like, 'It's fine, I'm in the system, we just have to trust it,' and Dad said, 'No, we're going private.'
"He said to me 'what would you do if it was Jack?', who was my son, and I couldn't argue with that because nothing would stop me doing that for my son."
That was Sunday - but on Monday he received a date for his colonoscopy in the public system, about six months after he first went to his GP. He was diagnosed with stage 3 bowel cancer and was straight into chemotherapy, radiation and surgery, finishing his final treatment on New Year's Eve 2021.
Since then, he has had three-monthly blood tests, an annual consult with the surgeon, and a colonoscopy every two years.
"I was very lucky that I did get seen when I did. Yes there was a bit of a wait, but I had a good outcome. With the rate the symptoms were accelerating, it could have been a different story."
Health NZ responds
Te Whatu Ora was unable to say whether other regions had also paused surveillance colonoscopies.
In a written response to RNZ, acting operations executive planned care Chris Simpson said MidCentral's endoscopy department had taken "a proactive approach" to communicating with patients and GPs about its capacity issues.
"We have taken several actions already to create more capacity including: the provision of additional weekly and weekend clinic sessions, some private outsourcing, locum gastroenterologist support, and we are actively recruiting to fill our workforce vacancies; however even with this additional work, we are still needing to prioritise acute referrals."
As of 4 December there were 852 patients on its surveillance waiting list, and they would be rebooked "in priority order" once capacity allowed surveillance colonoscopy procedures to restart.
"We understand that this could be distressing for our patients and recognise they will have concerns about what this might mean for them in terms of early prevention.
"Any patients with symptoms or concerns about their bowel health should see their GP who will work through options with the service."
Health NZ would be reviewing the waitlist monthly, and patients could expect an update for patients in May for what the service would look like from July.
Colonoscopies give 'bang for buck' - specialist
Bowel Cancer NZ medical advisor Professor Frank Frizelle said services must prioritise those with symptoms - but patients were put under surveillance for good clinical reasons.
"There is real potential here for people to fall between the posts, and it's a particular risk to what we can say are vulnerable patients."
Treating a polyp was "a lot cheaper than treating cancer", he noted.
"If you're looking for bang for your buck, surveillance colonoscopies deliver on that. And it looks like this [situation in MidCentral] is going to go on for at least another six months, or it's going to go on longer than six months because they're never going to catch up.
"It's going to go on for quite a while."
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