Wide Variations in Cancer Treatment Delivery Across Ireland Revealed in New HSE Data
New data published by the HSE has revealed wide and troubling variations in the delivery of cancer treatment across Ireland, with patients in some regions waiting significantly longer for radiotherapy, chemotherapy, and surgical procedures than those in others — a postcode lottery in cancer care that specialists say is costing lives and that demands urgent national action.
Background
Cancer is the second leading cause of death in Ireland, with approximately 25,000 new cases diagnosed each year and around 9,000 deaths annually. The National Cancer Strategy 2017-2026 set out an ambitious framework for improving cancer outcomes in Ireland, including targets for reducing waiting times, expanding access to specialist services, and improving survival rates across all cancer types. However, the implementation of the strategy has been uneven, and the new HSE data suggests that significant geographic inequalities in cancer care persist despite a decade of policy commitment to addressing them.
The variations in cancer treatment delivery are driven by a combination of factors including the geographic concentration of specialist cancer services in Dublin and Cork, workforce shortages in oncology and radiation therapy, capacity constraints at the country's eight designated cancer centres, and the logistical challenges facing patients in rural areas who must travel long distances to access specialist care. The HSE has acknowledged these challenges in previous reports but has struggled to develop effective solutions that can be implemented within the constraints of the existing health budget.
Ireland's cancer survival rates have improved significantly over the past two decades, driven by earlier diagnosis, improved treatments, and better coordination of care. However, the country still lags behind the best-performing European countries on several key cancer outcomes, and the geographic variations in treatment delivery are one of the factors that contribute to that gap. Patients in the west and north-west of Ireland, in particular, face longer travel times and waiting periods than those in the greater Dublin area.
Key Developments
The new HSE data, released this week, shows that waiting times for radiotherapy vary by up to six weeks between the best and worst-performing cancer centres. Patients attending the Cork University Hospital cancer centre wait an average of four weeks from referral to first treatment, while those attending centres in the west and midlands wait up to ten weeks for the same service. Similar variations exist for chemotherapy and surgical oncology, with patients in some regions waiting more than twice as long as those in others for identical procedures.
The data also reveals variations in the uptake of cancer screening programmes, with participation rates in BreastCheck, CervicalCheck, and BowelScreen significantly lower in rural areas than in urban centres. Lower screening uptake means that cancers are more likely to be diagnosed at a later stage in rural areas, reducing the effectiveness of treatment and contributing to poorer survival outcomes. The HSE has attributed the lower rural uptake to a combination of access barriers, awareness issues, and the logistical challenges of attending screening appointments in areas with limited public transport.
The National Cancer Control Programme has indicated it is developing a new equalisation framework that will set minimum standards for cancer treatment delivery across all regions and will require cancer centres to report publicly on their performance against those standards. The framework is expected to be published for consultation in the autumn.
Why It Matters
The geographic variations in cancer treatment delivery are not just a statistical curiosity — they represent real differences in the chances of survival for patients with identical diagnoses who happen to live in different parts of the country. A patient diagnosed with breast cancer in Dublin who receives radiotherapy within four weeks of referral has a measurably better prognosis than an equivalent patient in the west who waits ten weeks for the same treatment. The principle that where you live should not determine whether you live is one that the Irish health system has committed to in policy but has not yet delivered in practice.
The data also raises questions about the effectiveness of the National Cancer Strategy's implementation. The strategy set specific targets for reducing waiting times and improving geographic equity in cancer care, and the persistence of wide variations a decade after the strategy was published suggests that the implementation mechanisms have not been sufficiently robust. The National Cancer Control Programme has acknowledged this and has indicated that the new equalisation framework will include stronger accountability mechanisms than those that have been in place to date.
Local Impact
For patients and families in the west and north-west of Ireland — in counties Galway, Mayo, Roscommon, Sligo, Leitrim, and Donegal — the data confirms what many have long suspected: that the quality of cancer care available to them is inferior to that available to patients in Dublin and Cork. The Saolta University Health Care Group, which serves the west and north-west, has been working to expand its cancer services, but the pace of expansion has been constrained by workforce shortages and capital investment delays. Patients in these regions frequently travel to Dublin for specialist cancer care, a journey that adds significant physical and financial burden to an already difficult experience.
What's Next
The National Cancer Control Programme will publish its equalisation framework for public consultation in September 2026. The framework will set minimum standards for cancer treatment delivery across all regions and will require cancer centres to report publicly on their performance. The HSE has indicated it will seek additional capital investment in cancer services in the west and north-west as part of the Budget 2027 process, with a particular focus on expanding radiotherapy capacity at University Hospital Galway.
