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InvestigatesChemo DelaysCHEMOTHERAPY THAT CAN reduce the risk of breast cancer returning after surgery is not being given to many patients on time.
Systemic treatments such as chemotherapy or immunotherapy following surgery “are aimed at reducing the risk of the cancer coming back in the future”, Dr Michael McCarthy, consultant medical oncologist told The Journal Investigates.
When these therapies are required, it is particularly important to start them on time as their benefits “decrease over time”, according to the consultant.
This is recognised in a HSE key performance indicator (KPI) in which hospitals should start ‘adjuvant chemotherapy’ within eight weeks of a patient’s final surgery. Hospitals have a target to treat 90% of patients within this time.
But since 2023, all nine hospitals across Ireland who offer breast cancer treatment consistently missed this target, data obtained by The Journal Investigates through a Freedom of Information (FOI) request can reveal.
A shocking 13% of people with breast cancer attending Letterkenny University Hospital had this crucial treatment on time in the first quarter of this year.
University Hospital Limerick was not much better, with just 27% starting their chemo on time from January to March 2025.
Most other hospitals fell far short of the target, with many people across the country left waiting for this potentially life-saving treatment.
This particular KPI only applies to chemotherapy after breast cancer surgery.
It comes as our team reported last month that people were waiting longer to access chemotherapy and immunotherapy. In that report, we found almost half of hospitals missed the overall chemo treatment target in 2024.
But hospitals are faring even worse with this post-surgery KPI, with no hospital we obtained data on achieving the 90% target in 2024. The highest last year was 75%.
Timing is especially important for those receiving therapy post-surgery because it may be possible “to cure the cancer”, McCarthy explained. Delays can result in “a higher chance of cancer coming back”. He added that research shows:
If this adjuvant therapy is delayed, the survival outcomes will be worse.
“In general, across all cancer types, if you don’t get around to starting adjuvant therapy within, certainly 12 weeks of having your surgery, there’s probably no benefit to the therapy.
“It is clear cut,” he continued. “We should be doing better right across the country.”
A spokesperson for the HSE’s National Cancer Control Programme said it “remains fully committed to ensuring that all patients receive timely and equitable access to cancer treatment”.
This KPI “can be dependent on the capacity of the systemic anti-cancer therapy (SACT) ambulatory day ward”.
They added that “hospitals are expected to proactively monitor their performance against these targets, escalate concerns in a timely manner, and implement appropriate local mitigation strategies”.
Survival rates were consistently on the mind of Margaret Higgins when she was being treated for breast cancer.
After her lumpectomy surgery in 2023, her next step in treatment was chemotherapy and then radiation to help reduce the risk of her cancer returning.
“In your head, you’re ready to go… You have your life worked out for next year and half.
But then you’re just hit with this wall of: ‘No, we don’t have the appointments’; ‘No you can’t have your chemotherapy’.
Margaret told The Journal Investigates that she had to wait almost nine weeks after her surgery to even have her first consultation about her chemotherapy. At that she was told the earliest slot she could get to start her chemo was almost two months later.
That was a wait of 16 weeks, double that of the eight-week target.
She did not want to go private, but said she felt like she “had no choice”. She told her nurse: “I just can’t cope with this, the anxiety is crippling.”
Exactly a week later, she was sitting opposite a consultant in a private hospital. They slotted her in to start chemotherapy the following day.
“I felt like I won the lotto. That was my lifeline. I was just so happy.”
Her private care cost about €27,000 but this was covered by her health insurance.
Margaret then received radiation treatment in the public system and finished all of her treatment in March last year.
Thankfully, she is doing well now, but feels “the system is broken” and wishes “it wasn’t so difficult for people”.
Margaret was not alone in her wait for chemo. In 2023 and 2024, less than half of breast cancer patients in the Mater received their chemo on time after surgery.
A spokesperson for the hospital told us that they “cannot comment on individual patient cases for confidentiality reasons”, but added:
The Mater Hospital regrets any inconvenience caused to our patients due to not meeting these KPIs.
“We understand that any delays in treatment may be a cause of concern or additional stress to our patients and we apologise for this.”
The hospital said it “is constantly striving to improve its services to patients” and told us that this KPI improved to 83% during the first quarter of 2025.
“There is a high demand for this service and there were capacity issues in 2023. As a result, the Mater Hospital has explicitly focused on increasing capacity to allow new patients to attend.”
But many hospitals continue to poorly perform.
People attending Letterkenny University Hospital and University Hospital Limerick fared worst in recent years, with most not getting their chemo on time after breast cancer surgery.
The Co Donegal hospital has seen an improvement, according to a spokesperson, with the KPI increasing from 13% in the first quarter to 40% in the second quarter of 2025. They said:
“A dedicated four-chaired area within the inpatient oncology ward has been designated as a Day Unit extension for the delivery of [systemic anti-cancer therapy] to enable timely access to treatment. This has increased capacity and enhanced the hospital’s ability to deliver cancer care.”
A University Hospital Limerick spokesperson said the hospital is “committed to ensuring all patients receive cancer treatment in a timely manner and based on clinical need”.
They added that they are meeting KPIs around access to the Symptomatic Breast Unit and “reasons for non-compliance” with this particular chemo target include the fact that “additional investigations and procedures may be required” and “other medical reasons”.
Data from 2024 and 2025 was missing for Galway University Hospital and St James’s Hospital. There is a backlog in Galway’s data “due to workload demands” and this “is being actively managed”, a spokesperson told us. Data for St James’s is currently being validated “for submission”.
In order to improve access to day care wards, McCarthy told The Journal Investigates that they way hospitals are funded needs to change.
“I’ve been seeing bad KPIs for years,” he said. “But there’s no direct link between KPIs and resource allocation or service organisation.”
He said that “there doesn’t seem to be anybody” at a hospital or regional level who can authorise extra staff. Additional roles have “to be approved by the senior leadership of the HSE and that’s not an easy thing to achieve”.
Hospitals have told the HSE and Department of Health that they are struggling. “The answer back is: ‘We’ve no funding stream [to provide any extra support]. Just keep doing your best.’”
The HSE’s National Cancer Control Programme (NCCP) told us that “each hospital is accountable for ensuring that internal processes and capacity are sufficient to deliver timely treatment once a clinical decision to treat has been made”.
“While operational delivery lies with hospitals, the NCCP engages with the Health Regions and hospitals to enable performance at a system level.”
The NCCP also said it identifies “systemic barriers and supports collaborative solutions” as well as providing “targeted investment and guidance to support hospitals in achieving sustainable compliance with waiting time standards”.
Maria Delaney is the editor of The Journal Investigates. Our full series on cancer care delays can be read here >>
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