Cancer sufferer Lydia Staats has attended two funerals in the past year — both of them for women who, like her, had been waiting for radiation treatment to prevent a recurrence of their breast cancer.
The promised radiation never came, in spite of both women being on the Gauteng health department’s radiation waiting list. Their cancer metastasised before they could be treated.
Thousands are now facing a similar fate as the Gauteng health department gears up to contest a new push in the courts aimed at forcing it to get its house in order, amid no sign patients will be offered a better and more humane deal in the future.
Staats is among thousands of cancer patients waiting for treatment at Gauteng’s two cancer-treatment hospitals, Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg and Steve Biko Academic Hospital in Tshwane. Some have been waiting more than a year for the life-saving care.
In comparison, there are 791 patients on a waiting list of six to eight weeks for radiation treatment at public hospitals in KwaZulu-Natal, according to the provincial health department.
In the Western Cape, Jeannette Parkes, the head of radiation oncology at Groote Schuur Hospital and the University of Cape Town, said Groote Schuur patients were generally accommodated for a mark-up scan within 1-4 weeks, depending on the urgency of the case. From the time of planning the scan, patients started receiving treatment an average of four weeks later.
For the second time in two years, the Gauteng health department is fighting a legal bid to compel it to provide critical treatment that for many patients is their last chance for survival.
Patients’ hopes were raised — and then cruelly dashed again — early last year when a court application by the Cancer Alliance resulted in Gauteng health receiving R250m from the provincial Treasury for urgent cancer care. Despite the cash injection, and reasonable expectations there would be prompt and urgent action, little if nothing has been done.
The provincial Treasury described the budgetary top up in March last year as a means “to urgently address a backlog in surgical and radiation oncology services”.
In April, the health department said R534m was to be invested in equipment and R250m in outsourcing radiation for one year.
This dire state of affairs also contravenes Gauteng health’s own guidelines, adopted in 2018, which state radiotherapy for breast cancer must be done within 60 days of surgery, and no later than 90 days after it.
I felt like I was just thrown to the wolves. I have no words for the experience
— Lydia Staats, cancer patient
Staats, 46, a mother to two teenage girls, who lives in Springs, is living a nightmare. She was diagnosed with stage 3 breast cancer in February 2022. After chemotherapy and a mastectomy, after which cancer was found in three of the four lymph nodes removed during the operation, she was placed on a waiting list for radiation in February 2023.
Four months later, while still awaiting radiation, she went for a post-operative check-up where it was discovered her cancer had returned.
“When you have a recurrence, the cancer is more aggressive, so I had to start intensive chemo all over again.”
In September last year, it was found during another check-up that the cancer had come back. Surgery followed, and four of nine lymph nodes removed tested positive for cancer.
“I felt like I was just thrown to the wolves. I have no words for the experience,” she said.
On June 18 this year — after a nine-month wait — she began radiation. She has now completed the treatment and will this week hear whether it has been successful.
Figures released this week by Gauteng health reveal there are now 2,637 patients on the waiting list: 1,440 prostate cancer patients and 848 with other cancers waiting for treatment at Charlotte Maxeke, and a further 189 patients waiting for scanning and a 166 waiting for planning at Steve Biko. The information was provided in response to questions posed by the DA’s Gauteng shadow health MEC Jack Bloom.
Prompt radiation treatment is crucial for those diagnosed with and treated for cancer.
“You ideally need to start radiation within 12 weeks, because after that the chances of a recurrence are high,” said Louise Turner, COO of the Breast Health Foundation.
Turner said the backlog in treatment started in 2019 and worsened in April 2021 when a fire at Charlotte Maxeke caused the hospital to shut down, leading to the crisis that now means patients must wait an average of 18 months for treatment.
Section27, a public interest law centre that advocates for access to healthcare services and basic education, said there is no way to track cancer after surgery, and radiation is needed to kill off any remaining malignant cells. If this is not done quickly, cancerous cells can grow back or spread to other organs.
It said there had been no accurate record-keeping in this matter, and it was therefore not possible to say how many patients had lost the option of curative care.
The centre, together with Cancer Alliance and the Treatment Action Campaign, last month took the fight for better treatment of state cancer patients in Gauteng to the high court.
The organisations claim Gauteng health has failed to use the first tranche of R784m set aside by the Gauteng Treasury in 2023 to address the radiation backlog and other surgical logjams in the province. The money is to be paid out over three years, with the first payment of R250m made in March last year.
The court application was scheduled to be heard on July 23, but was postponed after Gauteng health filed its responding papers late. A date for the hearing is yet to be confirmed.
Staats’s case features in the court papers. “We are fighting for everybody,” Staats said. “We want to know what has been done with the money. We want to go to court and win.”
They told me, ‘Radiation is no longer a necessity for you’ and took me off the list. My days are numbered
— Thato Moncho, cancer patient
In their application, the organisations have asked the court to interdict the expenditure of the funds and preserve the R250m, direct Gauteng health to update the backlog list and start providing radiation and oncology services to these patients immediately, direct the department to report back to the court frequently on its progress, and declare the department’s failure to provide radiation treatment unlawful.
Cancer patient Thato Moncho was among those on the waiting list, but she has now been removed from it because her cancer has progressed too far for radiation to be effective. She believes she has been failed by the Gauteng health department.
“This is basically state-sanctioned murder,” Moncho said this week.
Moncho, a fitness instructor, was diagnosed with stage 2 inflammatory breast cancer in September 2020. She went for nine cycles of chemotherapy, followed by a lumpectomy, and was then put on the waiting list for radiation.
She waited a year, and when she finally began radiation, it was discovered the cancer had grown back. She started treatment again — chemo and a mastectomy in March 2023 — and was again put on the waiting list for radiation.
“This time, I fought hard to get radiation quickly. I was then given a date in four months’ time. I spoke to the head of radiation, but he said I must get in line. I begged and nobody listened.”
Moncho’s cancer came back three times while she waited for radiation treatment. “The oncologist told me, ‘Thato, all you need is radiation. If you do not get radiation, the cancer will keep coming back',” she said.
Moncho’s worst fears were realised in January last year. A scan revealed the breast cancer was back and had spread to her lungs. She was referred to medical oncology for palliative chemotherapy.
“They told me, ‘Radiation is no longer a necessity for you’ and took me off the list. My days are numbered.”
On Tuesday, she will begin another round of chemotherapy.
“I get calls from the school when my daughter has tearful days and can’t stop crying because she is scared I am going to die and leave her alone. If I get a headache or back pain, I am terrified the cancer has spread again.”
In its court papers, Section27 said outsourcing only the planning of oncology radiation is “irrational, arbitrary, unlawful and of no force or effect”.
"[We] truly believed the allocation of funds from [the] Gauteng Treasury would mean that Gauteng health would act with a degree of urgency, and that patients on the backlog list would get life-saving radiation oncology services urgently in the coming months. This was not to be.”
In the department’s responding papers, Gauteng health head of department Lesiba Malotana asserted the R250m was ring-fenced for oncology outsourcing. A tender had already been awarded. He said a proposed solution was now being implemented. This included:
- Increasing internal radiation oncology capacity by using Chris Hani Baragwanath Hospital and Dr George Mukhari Academic Hospital bunkers for the operationalisation of four linear accelerator machines for radiation treatment;
- Procurement of radiation oncology machinery to increase service offerings at Charlotte Maxeke and Steve Biko hospitals; and
- Outsourcing radiation oncology services to the private sector.
“The intention of the department is to find a lasting solution and, contrary to the suggestion made by the applicant that the solution is to outsource radiation oncology services to the private sector urgently and without following the normal tender process, that suggestion is expensive and not a long-lasting solution for the state, and, more than anything, the department views this as interference with its administrative powers.”
He said a tender had been awarded to Siemens Healthcare for outsourcing radiation oncology services for one year. Therapists were being recruited for Charlotte Maxeke and Steve Biko to provide overtime from 4pm to 7pm, Monday to Friday. There was also a plan to provide Saturday overtime for emergencies.
However, Section27 said the tender awarded is for planning, not treatment, “meaning that, in effect, cancer patients on the backlog list are still not receiving their radiation and oncology treatment, and no steps have been taken to clear the backlog”.
Questions were sent to the Gauteng health department at noon on Wednesday, but spokesperson Ireen Manyuha said the department would be unable to respond to the questions by the deadline of close of business on Thursday.
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.