Trust may reduce or delay chemotherapy because of staff shortages

Authors: Abi Rimmer 

Publication date:  11 Jan 2018

An Oxford hospital has said that it may reduce or delay courses of chemotherapy because it is struggling to recruit specialist nurses.

Andrew Weaver, head of chemotherapy at the Churchill Hospital, was reported by the Times newspaper to have emailed colleagues to outline proposals for the future of chemotherapy at the hospital.

“Currently we are down approximately 40% on the establishment of nurses on DTU [day treatment unit] and as a consequence we are having to delay chemotherapy patients’ starting times to 4 weeks,” said the memo, quoted in the Times report on 10 January.

Weaver warned that the current level of chemotherapy care was “unsustainable” given the limited number of staff, and he proposed that some later treatments to alleviate symptoms could be spaced out or cut down from six to four cycles.

However, Oxford University Hospitals NHS Foundation Trust, which oversees the Churchill Hospital, said that it had not made any decisions to delay the start of chemotherapy or to reduce the number of chemotherapy cycles for cancer patients.

In a statement the trust said that the internal email from Weaver set out “some of the challenges facing our chemotherapy service, with his ideas for how to tackle these issues, and invites constructive comments and alternative proposals from other cancer doctors and clinical staff.”

It added, “However, it does not represent a change to our formal policy for chemotherapy treatment. No such change has been agreed by Oxford University Hospitals NHS Foundation Trust.”

The trust added that no changes to chemotherapy would be made “before thorough consideration has been given to all possible options” and a formal proposal made to the trusts’ executive directors. Any changes would also need to comply with national guidance and evidence from the National Institute for Health and Care Excellence and others, it said.

Jeanette Dickson, vice president of clinical oncology at the Royal College of Radiologists, said that shortages of chemotherapy nurses on units was not uncommon. She highlighted a report published by Cancer Research UK in December, which showed that 73% of cancer staff thought that staff shortages were a barrier to providing efficient cancer treatments and excellent patient experience.[1]

“Work is under way by Health Education England and cancer charities to map the cancer nurse workforce, and this overview cannot come soon enough in order to help us properly plan nursing levels for the future,” said Dickson.

As well as nurse shortages, she said that shortages were affecting all professions working in cancer care. “The [Royal College of Radiologists] has been consistently calling for a robust, holistic approach to stem the shortages we are seeing across the entirety of cancer diagnostics, in addition to the non-surgical treatment workforce,” she said.

In October the college warned that the UK did not have enough radiologists to meet imaging and diagnostic demands in the NHS.[2]

Commenting on the situation in Oxford, Karen Roberts, chief nursing officer at Macmillan Cancer Support, said that proposals for changing chemotherapy arrangements “indicates that extreme staffing pressures are beginning to affect the quality of treatment patients receive.”

Harpal Kumar, Cancer Research UK’s chief executive, said that the organisation had been campaigning to urge the government to tackle cancer workforce shortages in the NHS for the past three years. He said, “It’s totally unacceptable that these shortages could lead to delays in patients getting cancer treatment.”


  1. Cancer Research UK. Full team ahead: understanding the UK non-surgical cancer treatments workforce—December 2017. 4 Dec 2017. [Link] .
  2. Rimmer A. Radiologist shortage leaves patient care at risk, warns royal college. BMJ  2017;359:j4683. [Link]   [Link] .

Abi Rimmer The BMJ

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