Warning on prospects to replace oncologists

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By REBECCA PALMER - The Dominion Post

Last updated 08:52 08/04/2009

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Numbers 'too low' for child cancer unit Cancer service in doubt Child cancer doctors quit Parents dread outcome of doctors' departure

The head of a national advisory group doubts Wellington Hospital will be able to find replacement paediatric oncologists to keep its tertiary child cancer service running.

Paediatric oncology steering group chairman Scott McFarlane, of Auckland's Starship hospital, said if a candidate talked to other child cancer specialists, or researched the unit's history, they were unlikely to see it as a stable, long-term prospect.

"I don't know of any informed paediatric oncologists who would now take that job."

Wellington Hospital's two paediatric oncologists - husband and wife Christian Kratz and Mwe Mwe Chao - resigned last month, less than six months after arriving from Germany. They leave in August.

Their resignations followed the departures of previous child cancer specialists Liz Hesketh in 2007 and Anne Mitchell in 2008.

Before Drs Chao and Kratz arrived, the sickest child cancer patients had to travel to Auckland or Christchurch for tertiary (complex and intensive) treatment.

Capital and Coast District Health Board said last week that the service's "on-again, off-again" history was not sustainable and it was looking for a long- term national solution.

Dr McFarlane said Wellington's tertiary services had been under threat for more than a decade.

The steering group, which would give advice to the Health Ministry about a long-term solution for Wellington, told Capital and Coast a year ago that the unit could not sustain any further crises, he said.

The situation was not Capital and Coast's fault. Increased specialisation among doctors internationally, combined with New Zealand's low population, meant specialist services became centralised in certain areas.

Tertiary child cancer units in Dunedin and Waikato hospitals had already closed.

The end of tertiary services at Wellington was "not a done deal but there seems to be an inevitability about it", he said.

Capital and Coast chief medical officer Geoffrey Robinson said the health board was using international agencies to find applicants to replace Drs Chao and Kratz.

Resignations put service in peril

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By SUSAN PEPPERELL - Sunday Star Times

Last updated 09:14 05/04/2009

Pressure is mounting on this country's child cancer services in the wake of the shock resignation of two specialists in the capital.

Doctors at Auckland and Christchurch say they will need extra resources to cope with the increased load they face if Wellington Hospital's child cancer service closes - which seems almost inevitable when the husband and wife team of paediatric oncologists, Christian Kratz and Mwe Mwe Chao, leave in August.

The couple, recruited from Germany only last October to reopen the service after their predecessors resigned, are moving to the US.

Ken Whelan, Capital and Coast District Health Board's chief executive, said the service had a chequered history and its future was now in doubt.

It is expected the remaining two tertiary child cancer units in Auckland and Christchurch will take over care of the Wellington region patients, who require highly specialised support services. There have been eight new patients in Wellington in the past six months. Starship sees more than 100 new patients annually, while Christchurch sees about 35.

Dr Lochie Teague, clinical director of paediatric haemotology and oncology at Auckland's Starship, said the last time the Wellington unit closed it caused additional stresses for everyone. "There is not much room for extra demand."

Child oncology also required a complex network of other medical specialties and taking on extra patients was a complicated equation.

"We will continue to offer services as best we can. If a child needs to be here we will always accommodate them," he said.

Dr Michael Sullivan of Christchurch Hospital's child cancer service said he and his colleagues were disappointed that the re- establishment of the Wellington service had failed and "more disappointed that it happened so soon".

Lucy needs isolation room

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Sunday Star Times

Last updated 09:14 05/04/2009

GARY RODGERS/Sunday Star-Times

STAYING PUT: Lucy Laws and her father, Michael, at their home in Wanganui.

Four-year-old Lucy Laws' condition has worsened. The daughter of Wanganui mayor Michael Laws has now been in isolation in Wanganui Hospital for more than two weeks, battling a virus.

Lucy, who was diagnosed with leukaemia a year ago, has no immunity and specialists have recommended she be transferred to Auckland's Starship hospital. However, Laws said he had been told Starship was so full that Lucy would be placed in a general ward in Auckland City Hospital, where she would be no better off than in Wanganui.

Lucy is running fevers every six hours. Her father said yesterday she had undergone platelet transfusions and faces further transfusions if her condition does not improve. Her chemotherapy, which involved three doses daily, has stopped to let her rebuild some immunity.

Her mother, Laws' partner Leonie Brookhammer, and six- month-old brother Theo are in her hospital room with her, but other family members can only view her only through a window.

On Friday Lucy's parents were told by a specialist paediatrician that her immunity had declined further and it was now urgent she be transferred to Starship where she can undergo more tests and stay in a pressurised isolation room.

However, none was available.

Laws said Starship specialists were talking to Lucy's doctors two or three times a day, which gave them a "certain confidence".

"The irony is that 20 years ago she would have died, but these days she, and children like her, have a shot at survival that is being compromised by a lack of facilities and shortage of beds, because there is no nationwide structure on the need for isolation rooms for kids."

Laws is on leave from the mayoralty, but said he planned to return to work tomorrow.

"It is very difficult, but like all families who have kids with cancer, you find ways of coping."

Parents dread outcome of doctors' departure

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By STACEY WOOD - The Dominion Post

Last updated 05:00 04/04/2009

Mothers of child cancer patients at Wellington Hospital dread the prospect of travelling to Christchurch or Auckland to get treatment for their children.

Palmerston North mother Nikki Christian already travels to Wellington with son Brayden, 7, once a week for chemotherapy treatments.

They have no friends or family in Christchurch and, while Mrs Christian's mother-in-law lives in Auckland, the inconvenience of travelling would be huge. "It raises so many questions.

"Where are we going to go? Do we have a choice? Do we drive or fly?"

Brayden has suffered from car-sickness since starting his chemotherapy and the added travel would cause him more discomfort.

Olivia Utting, whose son Elijah Utting-Parker, 4, has leukaemia, said she was "really scared" that the departure of the two paediatric oncologists would leave an unacceptable gap in expertise at the hospital. "These two doctors are incredibly qualified and the fact we got them here was so fortunate.

"[The DHB] said they've gone out of their way to keep them but I simply do not believe it."

Numbers 'too low' for child cancer unit

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By REBECCA PALMER - The Dominion Post

Last updated 05:00 04/04/2009

Low patient numbers and a need for highly specialised support services put the future of Wellington Hospital's specialist child cancer services in doubt, its managers say.

Ken Whelan, Capital and Coast District Health Board's chief executive, said yesterday that the paediatric oncology service had only eight new patients in the past six months.

The service had a chequered history, he said. "We can't have the service off-again, on-again."

The hospital's two paediatric oncologists husband and wife Christian Kratz and Mwe Mwe Chao resigned last month, less than six months after arriving from Germany. They leave in August.

Their arrival in Wellington last October ended nine months of the most vulnerable child-cancer patients being sent to Auckland or Christchurch for treatment. Mr Whelan said the hospital would continue providing tertiary child-cancer services till August, but would work with the Health Ministry and other district health boards to find a long-term solution.

"The reality is that providing paediatric oncology services is a highly specialised area and there are a lot of work force issues, especially in an area where the patient volumes are very small."

Money was not the issue. The hospital had put an extra $1.4million into the service. Capital and Coast child health services clinical director Graeme Lear said seven children were in the initial stages of treatment and another 30 were receiving chemotherapy.

The paediatric oncologists had done a "fantastic job".

Providing a high-quality, tertiary level child-cancer service required specialised support. That included staff in pharmacy, nursing, pathology and radiology and a paediatric intensive care unit. There was only one such unit in New Zealand in Auckland.

"We [Wellington] are not going to have a paediatric ICU because we don't have enough volumes coming through."

Dr Lear said if Wellington offered a secondary but not tertiary service, it would mean children would go to other centres for the intensive start of chemotherapy, "which is what makes the kids really sick". Follow-up care would be provided in Wellington.

A third paediatric oncologist, from Chicago, is due to start work in Wellingtonnext month, initially as a locum. She has been appointed for a three-month period but the board could extend the contract.

Paediatric oncology steering group chairman Scott McFarlane, of Auckland's Starship children's hospital, said Waikato and Dunedin hospitals had already been through a similar transition, moving from tertiary to secondary child-cancer services.

Laws blasts child cancer care

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4:00AM Sunday Apr 05, 2009
By Jane Phare

Michael Laws with daughter Lucy, who has leukemia. Photo / Wanganui Chronicle

Talkback host Michael Laws launched an angry and frustrated assault on health authorities last night over the care available for child cancer patients - including his daughter Lucy.

"The inadequacy of New Zealand's child cancer facilities has been pretty much brought home to me," said Laws, who is Wanganui Mayor and a member of the Whanganui District Health Board.

Laws said in the past week Lucy had deteriorated and needed a platelet transfusion. His daughter had no immunity and was at high risk of infection.

A range of options for Lucy's care had been canvassed with doctors but a room in Starship Hospital in Auckland was not considered an option because the hospital was too busy.

It came 18 days after Lucy went into isolation at Wanganui Hospital, and as child cancer services across the country face fresh pressure with the loss of two Wellington-based specialists. The pair - hired from Germany - quit six months after taking the job.

The resignations mean the centres for child cancer treatment might be again cut back to Auckland and Christchurch. It leaves families with long trips to those main centres or greater reliance on provincial hospitals where doctors use "tele-medicine" to communicate with specialists.

The Herald on Sunday has learned of some families with children needing regular care who have moved away from Wellington because of the inconsistent staffing and care.

Labour is calling for new Health Minister Tony Ryall to fix the problem.

Ryall acknowledged that the loss of the paediatric oncologists could be "upsetting" for families. He said a temporary paediatric oncologist had been hired and work was under way to fix the problem.

Laws highlighted the Wellington problem as placing greater pressure on the system, and said he had been told that ill children were unable to get into Starship Hospital's oncology wards.

He praised Wanganui hospital staff for their work. Not only had Lucy received excellent treatment there, but they had kept a room to the side of her room empty to help keep infection at bay, and turned away other child patients with infectious illness.

Dr Lochie Teague, clinical director of paediatric oncology at Starship, denied there was a waiting list for child cancer patients. He said if any child in a regional hospital got sick enough they would be transferred to Starship. "Space will always be made available."

Locum to hold together Wellington's child cancer service

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1:53PM Friday Apr 03, 2009

Wellington, April 3 NZPA - Wellington's child cancer service will be held together by a locum specialist while the search begins for permanent oncologists to replace the husband and wife team who quit yesterday, only six months after starting work.

Christian Kratz and Mwe Mwe Chao arrived from Germany with their family last October to reopen the service which had been forced to close by the resignation of their predecessors.

For nine months, gravely ill patients were sent to Auckland or Christchurch for treatment.

Dr Chao was not prepared to discuss why they were quitting, but said she and her husband were "really sorry it's not working out".

Capital and Coast District Health Board today issued a statement acknowledging the "positive work" the pair had achieved in their short time at Wellington Hospital, but gave no reasons for their departure.

Dr Chao and her husband, a world-leading researcher into the genetic origins of cancer, will leave for the United States in August.

A paediatric oncologist had already been employed and would start work in May, initially as a locum, said the DHB's clinical director of child health services Graeme Lear.

An international recruitment search was under way to find suitable specialists to fill the permanent positions.

"We are very conscious about the on-again, off-again nature of the service and believe the solution requires an integrated national service with close links to Auckland and Christchurch."

The service manages around 25 new referrals a year and provides highly complex treatments that in most countries were not usually available in public hospitals the size of Wellington's, Dr Lear said.

"We acknowledge that this news may be of considerable concern to our patients and their families and wish to reassure them and future patients in the lower North Island that we are doing everything to ensure continuing access to best practices in clinically appropriate timeframes."

Child Cancer Foundation central region chairman John Robson said Drs Chao and Kratz had provided excellent treatment and their resignations raised concerns about the DHB's ability to deliver on undertakings about the stability of Wellington's child cancer service.

- NZPA

Cancer appeal week is all about the kids

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By LUCY VICKERS - North Shore Times

Last updated 05:00 24/03/2009

Photo: LUCY VICKERS

BRAVE BATTLERS: From left: Bianca White, Zavier Coulam, Tui McLeod and Erfan Bour at the car signing event.

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Four brave children with one very important thing in common met at a Child Cancer event.

Zavier Coulam, 5, Bianca White, 5, Tui McLeod, 6, and Erfan Bour, 7, all have the illness and came together to sign a car which will be raffled off for the charity.

The children donned their colourful beads of courage – one for each procedure they’ve undergone.

Tui, from Birkenhead, was diagnosed with a brain tumour in June 2007 after being paralysed down one side.

She has finished her treatment and doctors are hoping the tumour stays dormant. Tui has 191 beads.

Erfan, from Glenfield, and Zavier, from Dairy Flat, have leukaemia.

Erfan has more than 1100 beads and Zavier has 240 for treatments such as lumbar punctures and chemotherapy.

Bianca, from Albany, was also diagnosed with leukaemia – two weeks before her fourth birthday in 2007.

Her mum, Lea, was tying up her daughter’s hair before her ballet lesson when she noticed a swollen gland on her neck.

Blood tests revealed an abnormally high white cell count and Bianca was given an immediate transfusion.

In the first four months Bianca spent 65 days in hospital, 34 of those in isolation.

She has 960 beads.

More than 150 children are diagnosed with cancer each year. The Child Cancer Foundation provides support to children with cancer, their families and the health professionals who treat them.

They need volunteers for this week’s street appeal, phone 0800 4CHILD (0800-424-453), visit www.childcancer.org.nz or email mthomson@childcancer.org.nz.

Child cancer doctors quit

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By KERI WELHAM - The Dominion Post

Last updated 05:00 03/04/2009

CRAIG SIMCOX/The Dominion Post

HARD TRAVELLING: Wellington cancer patient Stephen Uelese and his mother, Marika Broad, endured months of fortnightly trips to Christchurch for treatment before the two doctors arrived.

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Wellington Hospital's embattled child cancer ward has been plunged into chaos by the resignation of two paediatric oncologists only months after they arrived to save the service.

Husband-and-wife team Christian Kratz and Mwe Mwe Chao have quit because of "insurmountable" problems less than six months after they moved their family from Germany to Wellington.

Their arrival enabled Wellington Hospital to resurrect its troubled child cancer service in full, after nine months of being forced to send gravely ill patients to Auckland or Christchurch for treatment.

Now, with the specialists' announcement that they leave for the United States in August, the future of the service is again uncertain. Parents of young cancer patients said they were devastated by the news.

Child Cancer Foundation central region chairman John Robson said: "Clearly there are some fundamental issues that have proved insurmountable to the new paediatric oncology team, which is a huge disappointment to us."

Mr Robson said the two specialists had provided excellent treatment. Their resignations raised concerns about Capital and Coast District Health Board's ability to deliver on undertakings about the stability of Wellington's child cancer service.

The board said it would comment today. Dr Chao said she was not prepared to discuss the couple's reasons for quitting, but said she and her husband were "really sorry it's not working out".

"It has been a pleasure caring for these wonderful families and these beautiful children," she said.

Dr Chao, an American, and the German Dr Kratz, a world-leading researcher into the genetic origins of cancer, were employed to replace Liz Hesketh, who resigned in July 2007, and Anne Mitchell, who quit in January 2008.

In the nine-month gap before their arrival, many patients from Wellington and surrounding regions had to travel to Auckland or Christchurch for treatment.

Marika Broad, of Wellington, had just 24 hours to pack and get her family on a plane to Auckland when her nine-year-old son, Stephen Uelese, was diagnosed with cancer in October 2007. They were in Auckland for six weeks, and then spent eight months travelling to Christchurch for fortnightly treatment.

"It was like going to hell and back," Miss Broad said yesterday. "Our children aren't getting looked after properly. They are getting shoved around the countryside when they have a life-threatening disease."

The board announced last year that it planned to recruit a third paediatric oncologist.

WARD 18 WOES

July 2007: Paediatric oncologist Liz Hesketh leaves for Australia. The unit closes to new patients because the hospital cannot guarantee clinical safety. Over the next 12 months, 45 children are sent to Auckland or Christchurch for treatment. Dr Hesketh later tells The Dominion Post she left because of "dwindling resources and a unit moving toward unsafe clinical practice".

January 2008: The sole remaining paediatric oncologist, Anne Mitchell, quits. Clinical support from Christchurch keeps the ward afloat.

October 2008: World-class paediatric oncology duo Christian Kratz and Mwe Mwe Chao move from Germany to run the service. The husband and wife team talk of wanting to raise their family in Wellington.This week: Dr Kratz and Dr Chao quit.

Children's hospital stays put

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RUTH HILL - The Dominion Post

Last updated 10:33 24/02/2009

MAARTEN HOLL/The Dominion Post

FAMILY ROOM: Anna, 21, Joshua, 13, and mum Helen Wood at Wellington Children's Hospital. Joshua is would rather be further away from kids with contagious diseases 'because my immune system is not working so well'.

Plans to move Wellington Children's Hospital into an old tower block have been scrapped because patients would be worse off.

In a memo from clinical director Graeme Lear and child health managers, staff were told the proposal to shift to the 30-year-old Grace Neill Block was no longer considered workable because of "a serious and insoluble" lack of storage and cramped rooms, which meant parents would have been unable to stay with their sick children.

"We will not be able to provide a physical facility `significantly better than what we have now' which has always been the bottom line in any proposal to move from the current children's hospital."

The 11-storey Grace Neill Block, being vacated by women's health and maternity services this week, was targeted for demolition with the opening of the new regional hospital. But Capital and Coast District Health Board was forced back to the drawing board when it was revealed the new hospital would not be big enough.

Last April, interim chief executive Derek Milne announced plans to retain Grace Neill to house child health services, and convert the children's hospital into offices.

The latest plan involves moving child outpatients to Grace Neill to free up space in the existing children's hospital, and bringing forward plans to build a new facility within 10 years.

It depends, however, on "the availability of government funding, and this in turn depends on the ability of Capital and Coast to emerge from the financial troubles of the last few years".

The board faces a $70 million budget blowout this year.

The current children's hospital was built in 1988, but has struggled to accommodate services, including child cancer.

It is believed a lack of progress on creating a separate unit was one factor in the resignations of the hospital's previous two child cancer specialists, which meant the hospital was unable to accept new cancer patients for 15 months.

A board spokesman said the change of plans would not jeopardise redevelopment of child cancer services.

Paediatric oncology has had its own "designated area" within the children's hospital for a year and management was working with the two paediatric oncologists to improve its layout.

Negotiations are under way with a third specialist to join the team.

Thirteen-year-old Joshua Wood, who has leukaemia, said he was impressed with the food and the nurses at the hospital. "But one thing I don't like is being so close to other kids with contagious diseases that I can catch because my immune system is not working so well."