The Decibel - B.C. is sending thousands of cancer patients to the U.S.

Episode Date: June 19, 2023

British Columbia will send cancer patients across the border for radiation therapy to deal with growing wait times and backlog at home.The plan will cost the province three times the amount for treatment at home. Globe and Mail reporter Andrea Woo explains how this will work and what this says about the state of our healthcare system.Questions? Comments? Ideas? Email us at [e-mail]

Healthcare systems across the country have been struggling, but B.C. is dealing with a big issue. It can no longer provide timely cancer care for some patients. So, it's sending them to the U.S. Starting May 29, 2023, B.C. Cancer will offer eligible patients the opportunity to have their radiation therapy at one of two partner clinics in Bellingham, Washington. Andrea Wu is a Globe and Mail reporter in Vancouver who's been following this story. She'll tell us what it means for cancer patients and their treatment, and why it's a sign of a broken system in need of change. I'm Maina Karaman-Wilms, and this is The Decibel from The Globe and Mail.

Andrea, thank you so much for joining me again. Thank you for having me, Mainika. So I think this honestly might come as a surprise for someone not in B.C., that the province is now sending cancer patients to the U.S. to get treatment. But Andrea, I know you've been reporting on the health care system there for a while. Did you see something like this coming? We have known for at least a decade that we would have a huge increase in cancer incidents owing to the province's growing and aging population. So the fact that we're sending patients south, you know, maybe that wasn't exactly predicted, but the capacity issues that we're seeing now were not a surprise. Okay, so let's actually get into some of the issues behind this initiative then. So, I mean, we know that healthcare systems have been overwhelmed across Canada recently, but what are the specific reasons behind why BC is sending these patients across the border?

So in British Columbia, we've been seeing a growing backlog and growing wait times for radiation therapy. And so in response, the BC government is sending about 50 patients per week to two private clinics in Bellingham so they can have faster access than they would here at home. So this will begin with breast and prostate cancer patients because they are the largest groups of patients receiving radiation therapy and because they are more able to travel for treatment than some other groups. So they will be prioritizing or offering this to people who require shorter treatment courses. So typically five fractions or five sessions of radiation. So it's one per day.

So they would be there for about five days plus consultations, et cetera, on either end. Okay. And when you say a fraction, that's just a session of radiation treatment then? Correct. Okay. Yeah. When you say a fraction, that's just a session of radiation treatment then? Correct. Okay. So some people who require 20 to 30, for example, they would not be offered this opportunity. So as of Tuesday, June 13th, 87 BC cancer patients have been referred by their oncologist for radiation therapy for treatment in Bellingham. And of those, 38 have

booked travel. Of those, nine have received a consult with an oncologist at one of the clinics in Bellingham, and two have started treatment. Okay, so why exactly can't BC treat patients in province? I mean, I know this is a big question here, but what kind of triggered the decision, I guess, to send patients away? So there are several, but the main reasons are that we have a growing and aging population. We have a cancer system that is nearing, and some would argue, at capacity. And as a result of that, wait times for radiation therapy are among the longest in Canada. Okay. Wait times are always a big issue when we're talking about cancer treatment.

What is the situation in BC right now? How long are people waiting for treatment? So for radiation therapy, and about half of people diagnosed with cancer will require radiation, our wait times in BC are among the worst in Canada. and about half of people diagnosed with cancer will require radiation. Our wait times in BC are among the worst in Canada. It's second behind only Nova Scotia, I believe. So in 2022, about 85% of people in British Columbia requiring radiation therapy were able to start within four weeks, which is the national benchmark for the maximum

amount of time that's deemed appropriate to wait. 85%, that doesn't sound terrible, but the national average is 96%. And also, when you look at more current data, which is not easily accessible because we don't publish this publicly, but oncologists within the system have sent us information on wait times. And as of this spring, as of May, it was at about 77%. Okay, so only 77% of people diagnosed who need treatment are hitting that four-week treatment timeline. There's a good percentage of people then that are not getting that immediate treatment. Correct. And also this is only one step of the waiting process for cancer treatment overall. There are many sections of wait times. So for

example, waiting to see an oncologist for a first time and once there has been a decision to treat, the time from decision to treat to the commencement of treatment and there are many different phases and so that is just one. And when you talk about like 77 seems pretty low when we're talking about the national average of close to 97%. That's a big difference. How significant is that actually for a patient's treatment, though? Like a delay in cancer treatment, what kind of difference does that make? who has received a cancer diagnosis or who has a loved one who has received a cancer diagnosis knows that the anxiety of not knowing is sometimes as bad as the diagnosis itself.

So you know that you have cancer, you know that timely treatment can be critical for survival and recovery. And you're just not hearing anything about what your treatment course is going to be like. And it's not just anxiety and uncertainty. I mean, there was a study published in the British Medical Journal in, I believe it was late 2020, that found that delaying cancer treatment by even a month can increase a person's risk of dying by 6 to 13 percent and that further delays were associated with higher mortality. I guess, why send people to the States, Andrea? Why not send patients to another province instead to get treatment? The Ministry of Health said BC Cancer did explore other options within Canada.

They didn't say which provinces specifically, but they said that none were available because other provinces were either dealing with their own capacity needs, or were already assisting other provinces. And I mean, logistically, Bellingham is not a bad option. It sounds somewhat dramatic to say that we're sending patients out of the country. But if you're in Metro Vancouver, like I'm downtown Vancouver right now, it would take about 90 minutes to drive to Bellingham. And so in many cases, that would be more convenient than getting on a plane and going to Alberta or to Ontario. But that also comes with a border. And so if you don't have passport issues sorted out or anything like that, if your companion can't cross the border for whatever

reason, then that is another hurdle. It does seem like BC has fallen behind a lot of the rest of the country a little bit here. Do we know how this happened or why? Yeah, I mean, when you talk to those past presidents, some of them were quite certain that it was a change in leadership at BC Cancer and that there were all these added layers of bureaucracy so that the president of BC Cancer no longer had a direct line to the ministry and minister of health and that cancer seemed not to be a priority as it once was. So 15 years ago, for example, BC Cancer was considered probably the best cancer agency in Canada, and it was highly regarded around the world. There was very impressive research coming out of BC

Cancer. And as, according to the past presidents, as priorities shifted, and, you know, the 90s came and it brought new fiscal constraints, as all this was happening, BC Cancer invested less in building new capacity and hiring researchers from around the world and just began to stagnate as other cancer centers in Canada improved their performance. So this really does go back like a couple of decades, it sounds like, and it's been building up until this point then. Yeah, it is not the fault of any one government, but this is a very big problem that began a long time ago that was not met with the response that it should have been. I wonder, has Canada done this before to send patients to get treatment in the U.S. because Canada can't provide care? Like, is this the first time we're doing this? Centers in Victoria and Kelowna were awaiting new CT scanners. Ontario has also sent patients to Buffalo, to Detroit, to Cleveland for radiation therapy,

for stem cell transplants, and for other life-saving treatments. Quebec has sent cancer patients to Vermont. Those are just a few examples. So the idea of sending patients outside of the province is not new. What is new is the volume. Having to send close to 5,000 patients out of country for at least a couple of years and very likely longer than two years, that is not something we have done before. Andrew, we've been talking about a lot of the logistics here, which are important, but I guess we should also talk about the emotional aspect to this, right? Because getting treatment for cancer can be really scary.

And I imagine that most people want to be around their family and their friends, their support network. So from the experts, the doctors that you've talked to, how does sending patients to another country to receive treatment, how does that impact their ability to have a support system and cope with everything? To the BC government's credit, they will be picking up all of the costs of sending a patient to Bellingham, and importantly, also the cost for a caregiver. So they will cover flights or car rentals or mileage or anything like that for a patient and a companion. But that's the one person. Hopefully, ideally, you would not be in Bellingham for very long. Again, they're prioritizing people who would only require about five days worth of treatment. But it does.

I mean, mentally, having to leave your country and leave your home and to be staying in a hotel while you're going through this is not ideal for anyone. Does the province book all of those things? Or do people have to go and like book hotels and figure out their travel on their own? Nope, that is all covered by the province, they will have a team coordinating it all. Yeah. And I guess we should acknowledge too, of course, that a lot of people in Canada have to travel for cancer treatment as well. If you're in a big city, you're in a good position, but in a lot of more remote communities, you do have to travel and probably leave your support network in order to do this as well. That is a very good point. Cancer

centers are usually located in major urban areas. And so, correct, like if you're living somewhere rural and remote, you would have to travel to a bigger city anyway. We'll be right back. All right, Andrea, we haven't talked about money yet, but I imagine this cannot be cheap. So, how much does it actually cost to send patients across the border for treatment? So for five fractions of radiation, it would cost $3,854 here in BC. At the private cancer centers in Bellingham, it would be $12,277. So about triple the cost. And that is for the radiation treatment alone. That doesn't include other expenses such as travel for hotels,

for meals for the patient and the caregiver, which easily amounts to thousands more. So the Ministry of Health says it's earmarking up to $39 million per year for this initiative, and that includes $5 million annually in contingencies. All right. I mean, it seems like it can't really be sustainable for the government to be paying this much for long, right? Like, what has the BC government said about how long they'll be doing this for and what their long term plans are? So the Ministry of Health and Minister of Health Adrian Dix says this is a temporary initiative that will help some patients get faster access. In the meantime, there are also a number of initiatives to build up the system here in BC.

So we currently have six cancer centers in BC. There are two more planned for Surrey and for Burnaby, and those are tentatively scheduled for completion in, I believe, 2027 and 2028. About a month ago, the BC government announced that concept plans had been approved for new cancer centers in Nanaimo and Kamloops. And both of those, they said, would open in 2027. So sorry, it sounds like the plan is to still send people across the border until these centers are up and running then. So for a few years. Mm-hmm. When they announced this, they mentioned the costs for the next two years. But there's some doubt whether this will actually, quote unquote, only be two years or this will continue on beyond that. And so what's the government doing now,

like in the short term to help fix this problem? They recently announced a 10-year cancer plan, and a big part of that is hiring more oncologists and radiation therapists and medical physicists as part of that cancer plan. There are currently dozens of jobs being posted. They have made some decent progress in hiring so far. There have been increases in pay. I believe there's work underway to replace linear accelerators, which are the machines used in radiation therapy. Andrea, when we're talking about this plan to send people to Washington State for treatment, I'm wondering how this is being received in BC. So, you know, those who treat patients and even the patients themselves, do we have any sense of what they think of this plan?

So there's been a lot of discussion about whether this is good news or bad news. And I would say that the reality is that it's both. You know, it's good that the government is taking the step to provide people with faster access to treatment for a disease where timely treatment is very important. It's bad that we are in a position where we need to be sending people out of country for care when we have known for more than a decade that we have a rapidly growing and aging population. When we have known that cancer risk increases with age, when we have known that our cancer system has been nearing, if not at capacity, for more than a decade. So it's very good that this option is being made available. It'll mean a world of difference to a lot of people. This makes me wonder about our healthcare system on a bigger

scale, right? Because if BC can't necessarily treat patients there, if other provinces in Canada also didn't have the capacity, and we're going to have to send people from our public healthcare system to the private system in the States, I mean, isn't that kind of an argument for private over public healthcare? So that's a very interesting one, because BC has been very vocal in its opposition to the privatization of health care. So the BC government has staunchly defended the public health care system, saying it's not perfect, but it's very important that we uphold it. And so, of course, there are people who are pointing at this as hypocrisy now because you're saying, you know, we're defending the public system, but at the same time, we're spending tens of millions of dollars to send people to private clinics in Bellingham. Yeah, that's kind of hard to square. Just lastly here, Andrea, I mean, this is a pretty big change for cancer patients in the province.

And right now you said it's, you know, it's just a select group of patients that will actually get sent to the US for treatment. But going ahead, it sounds like this is going to be in place for a few years. Do we think that this is actually going to open up for a broader section of cancer patients? It is possible. The wording was very particular when they announced this. I believe they said that they were starting with breast and prostate cancer patients. So suggest that conceivably it would be expanded to other people. But I mean, the hope is that this is a temporary initiative as described that with cancer centers coming online and with structural changes to how we're paying doctors in BC, that things will improve. I mean, these are actions being taken now that we will not begin to see the results of for years into the future. But I mean, the hope is that it will be enough. Andrea, thank you so much for taking the time to speak with me.

Thank you so much for having me. That's it for today. I'm Naina Karaman-Welms. Our summer producer is Nagin Nia. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Adrienne Chung is our senior producer, and Angela Pachenza is our executive editor.

Thanks so much for listening, and I'll talk to you tomorrow.