He needed surgery, but he also needed chemotherapy.

If the Hunter Region’s health services met accepted benchmarks, the man would have started the chemotherapy within three weeks.

Instead he received a letter saying he had an appointment for his treatment to start on February 22, and even that date was only achieved after his surgeon, Dr Vanessa Wills, spoke with a liaison nurse.

Wills complained, and kept complaining, throughout last week (January 17 to 21) until her patient was told he had an appointment for his treatment to start next week.

‘‘It’s not just an isolated case. It happens quite frequently,’’ she said.

‘‘It would have been reasonable if he’d been given an appointment for January 14 or 15, or within a month of diagnosis. February 22 was unreasonable.’’

Not to mention a long way outside the three-week benchmark that is achieved in other parts of the state, but not the Hunter Region.

On any day, 100 people among the area’s 480,000 will be waiting to see a medical oncologist. Those 100 people will have been told they might have cancer.

The accepted benchmark says they should wait for only three weeks. In the Hunter the average wait is eight.

Nine out of 10 of them will be given a cancer diagnosis, requiring treatment. They will wait five weeks, on average, for treatment to start. The benchmark is three.

The bottom line is that Hunter patients, on average, wait 13 weeks between diagnosis and treatment of cancers like breast, lung, prostate, bowel, gastrointestinal and gynaecological cancers, when best practice says they should wait six weeks.

Said a health worker diagnosed with breast cancer in 2009, who opted for chemotherapy in a private hospital to free up a public hospital spot, but still waited 10 weeks for treatment: ‘‘What we have in the Hunter is a patched-up cancer service that’s spread between the public and private systems, covers a huge area and relies on too-few specialists, and you only realise what a hodgepodge it is when you really need it.’’

In the past few years the focus of the Hunter’s cancer treatment problems has been radiotherapy, and the campaign for more linear accelerators.

The Calvary Mater Hospital, which provides cancer care for Hunter New England Health Service, now has five.

But at the same time waiting periods for patients requiring chemotherapy have lengthened because of a growing population, not enough medical oncologists, and funding constraints.

According to the Australian Medical Oncologist Workforce Study in 2009, the region should have 11 full-time medical oncologists. There are roughly six.

The study recommends the optimum number of new patients a medical oncologist should see each year is between 150 and 180. The accepted NSW benchmark says no more than 200.

The Hunter’s medical oncologists average 240 to 250 new patients each year.

The need for more medical oncologists – at least two – and more specifically the need for funding of chemotherapy chairs, nursing staff, pharmacists and other allied health professionals to support extra oncologists, has been repeatedly raised with the NSW government.

The government has also been told that delays have meant some patients are too ill to receive treatment, while others have died before they’ve even seen a medical oncologist.

The medical oncology delays are also having an impact on surgical and radiotherapy cases, doctors say.

Wills, a surgeon who sees oesophagus and stomach cancer cases, said many patients required chemotherapy before surgery to reduce their cancers.

‘‘It’s often quite time-critical,’’ she said.

In some cases patients with cancer of the oesophagus were unable to eat because their oesophaguses had closed due to the cancer growing while they waited for chemotherapy.

‘‘There are some cases where even an extra week or two is significant,’’ she said.

Wills has worked in Newcastle since 2002 after a period in Sydney.

‘‘It’s been noticeably getting worse here in the past few years,’’ she said. ‘‘We used to be able to ring up and get people into treatment within a couple of weeks.’’

The disparity between waiting times in the Hunter and waiting times in Sydney was also striking for anyone who has worked in both areas, she said.

‘‘If you ring up a specialist in Sydney they’re usually looking for work.’’

It’s led to a percentage of patients taking ‘‘the Sydney option’’ when their doctors have referred them to a medical oncologist to confirm a suspected cancer diagnosis, where Hunter people will access Sydney health services, usually through relatives living there.

While patients are already taking the option, Wills said she was surprised when specialists at a multidisciplinary meeting last week were told to suggest to their patients that they take ‘‘the Sydney option’’ to beat the Hunter waiting lists.

Wills said she understood her colleagues’ frustrations but. ‘‘I said at the meeting that I didn’t think it was appropriate’’.

Ross Fleming, 56, is receiving chemotherapy treatment for pancreatic cancer at Wagga Hospital after he was diagnosed at Newcastle.

He grew up in the area, his extended family still lives here, and when he was told he had a kind of cancer that kills 95per cent of people within five years, he wanted treatment at Newcastle.

‘‘We trusted Newcastle,’’ his wife, Kim Hadley, said.

But when her husband was told on November 28 that he would have to wait two months for chemotherapy, Kim Hadley said forget it, and started making some calls.

‘‘As I said when they told Ross he would have to wait for two months, ‘One minute you’re telling him he’s got a fast-growing cancer that kills people quickly, and the next you’re saying he has to hang around for two months before you can help him’,’’ she said.

‘‘This is not a third world country. Cancer is not like having to wait for a knee reconstruction. Time matters.

‘‘My son was diagnosed with leukaemia at the Mater in Newcastle on April 28, 1982, and he lived for another eight years, seven months and two days, and in all that time no one ever said he had to wait two months for treatment.’’

Laraine Dunn’s late husband, Gary, was diagnosed with cancer in December 2005.

Gary Dunn had surgery just two weeks after his GP referred him to a specialist with suspected cancer.

But when he tried to make an appointment to start chemotherapy and radiotherapy in Newcastle he was told the earliest starting date was mid February.

He went to Sydney and started his treatment on January 11.

‘‘It cost quite a bit to stay in Sydney for three months from Monday to Friday,’’ Laraine Dunn said.

‘‘Because we lived in Newcastle we did not qualify for the cheaper accommodation available to country patients. We stayed in motels and tried to keep it to $100 per night.’’

Sally Ewin is a physiotherapist and lymphoedema therapist, and spokeswoman for the Maitland Cancer Support Group, who knows what it’s like to be told you have cancer, but you have to wait for treatment. She was diagnosed with breast cancer in December 2003 and had surgery in a private hospital in January 2004, followed by radiation therapy at the Mater that finished on Ash Wednesday – a fitting date, she said.

Even the wait over Christmas for surgery in January was a struggle, she said.

‘‘It’s the fear that the cancer’s spreading in your body every day. The fear of the unknown and what it’s doing to you.

‘‘For a lot of people it’s like start the treatment, the sooner the better. You want to fight but then they’re holding you back.’’

In October 2008 there was more surgery after a routine check-up led to investigations and the grim news that the cancer had returned and spread to her armpits.

She had chemotherapy in the private system because of delays in the public system, and radiotherapy at the Mater that started, coincidentally, on Ash Wednesday.

She is thankful she had options because of private health insurance, but said: ‘‘It’s only when you’re in the system that you realise there’s lots of little problems.’’

Through her work and through the cancer support group she is aware of other patients who have had problems with cancer diagnosis and treatment waiting periods.

‘‘I think most people take the view that we accept the system is doing the best it can,’’ she said.

‘‘People find themselves in a system that’s not perfect but they go along with it because we understand it’s a health system in crisis, so people are forgiving.’’

A health worker who does not want to be identified said delays receiving cancer treatment were not confined to the public system.

‘‘I’m in the health system. I know how things work, but I had to wait 10 weeks between diagnosis and chemotherapy because of the systems that are in place.’’

She had surgery for breast cancer, followed by a series of referrals and assessments before chemotherapy at a private hospital.

‘‘There are only so many medical oncologists and only so many slots where chemo can be administered, and at each step of the way while you’re being assessed there are delays.’’

Twenty minutes before her first chemotherapy appointment, while she was on her way there, she was rung to say it had been cancelled until the following week.

She did not take the news quietly, she said, and the hospital was forced to reschedule her chemotherapy to an earlier date.

‘‘You can imagine what a 10-week wait for chemotherapy was like after surgery for an aggressive cancer. From diagnosis to surgery was one week, and then the brick wall came.

‘‘Regardless of which system you’re in, private or public, there are problems in this area. It covers a huge geographical area, but it’s a patchwork system, and it’s breaking. It’s bending, and it’s snapping.’’

Professor Jim Denham is a Newcastle radiation oncologist and director of the Newcastle University Prostate Cancer Trials Group.

While the majority of prostate cancer patients receive radiotherapy, surgery or hormonal therapy to treat their cancer, advanced prostate cancer patients also receive chemotherapy, and the medical oncology delays ‘‘do impact on prostate cancer outcomes’’, he said.

Professor Denham has been part of a team that has seen prostate cancer mortality rates drop significantly in 20 years, but still remain high compared with other areas including Sydney.

NSW Cancer Registry data in October last year showed the Hunter’s prostate cancer death rate fell from 43.4 per 100,000 men in 1990 to 33.4 in 2008. Central and southern Sydney fell from 43.6 per 100,000 men to 24.8 in the same period.

The Prostate Cancer Trials Group is conducting a trial in conjunction with Boston University and using the drug Docetaxel to treat advanced cancers that have not produced secondary cancers.

The trial was very promising, he said, and illustrated the ‘‘big growth in chemotherapeutic agents’’ in treating prostate cancer.

Health representatives contacted by the Newcastle Herald confirmed significant concerns about lengthy waiting lists for patients seeking cancer treatment, but declined to comment on the record.

‘‘It’s such a sensitive area,’’ said one senior health official, who described waiting times as ‘‘horrible’’.

‘‘There’s an election coming up and health is such a political issue, but there’s absolutely no doubt that people are not getting the cancer treatment in the times that they really should.’’

In a single week before Christmas, Wills saw eight new stomach and oesophagus patients, and made calls on behalf of several of them who required urgent treatment.

The ‘‘hassling’’ calls were becoming more frequent, she said.

‘‘I’m kind of getting tired of having to do it, but if you were to check with most of the general surgeons, liver surgeons and colorectal surgeons, we’re all having to do it, and everyone feels the same way.’’