The Decibel - How soaring B.C. wait times are hurting cancer patients

Episode Date: November 24, 2022

Cancer patients are facing lengthy wait times to see a doctor and get treated in British Columbia. These delays are not only stressful for the patient, they allow the disease to grow and become more complicated.This is a massive change from a few decades ago when B.C. was seen as a leader in cancer care. Globe and Mail reporter Andrea Woo explains how these delays got so bad.Questions? Comments? Ideas? Email us at [e-mail].

Hi, I'm Mainika Raman-Welms, and you're listening to The Decibel. There was a time when British Columbia was known for its cancer care. The provincially funded organization, called BC Cancer, was a global leader for treatment and research. But now, the province has some of the worst delays in all of Canada, which means more patients are suffering and some are dying before they even see an oncologist. Andrea Wu is a Globe and Mail reporter in Vancouver. She's been investigating how bad the delays are and why BC has fallen so far behind. This is The Decibel from The Globe and Mail. Andrea, thank you so much for talking to me today.

Thank you so much for having me. So as part of your reporting on this story, you spoke with people who are struggling in the cancer care system in B.C. Can you tell me about Lorraine Glover? Lorraine Glover, she's 71 years old. She's a retired office administrator living in Victoria, and she's had cancer twice. So the most recent time, June 2021, she felt a lump in her breast, was very worried, understandably. But her thoughts immediately went back to the first time that she had had cancer almost 30 years earlier. And that time, the whole ordeal was over within two months.

So she was worried, but she thought of that other experience. We have a great medical system. I'll be fine. But unfortunately, she had a very different experience this time. It was two months just to get an MRI scan before the cancer clinic would accept her. She needed surgery, but an operating room couldn't be booked for another month later. Biopsy pathology reports, which she needed a few of, took weeks to come in each time. And altogether, the process stretched over a year. Wow. That's a really stark contrast then between her experience 30 years ago and her experience in 2021. How common would you say is Lorraine's story? To be fair, this is not the case with everyone. We do hear

about people who need cancer treatment and are able to get it in a timely fashion. But there has been a big difference over the years. And we're hearing more and more stories of people who are waiting months instead of weeks now to get treatment. What kind of impact are these delays having on patients' ability to make decisions about their health care then? So timely treatment is very important when it comes to cancer. So there was a study published a couple of years ago in the British Medical Journal that found that delaying treatment for cancer 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. Wow. Yeah, so Lorraine was saying that the anxiety was the worst part for her and it actually rivaled the cancer diagnosis itself because she would be terrified to walk away from her cell phone for a while because if she missed a call, she missed an appointment, she wouldn't know how to get a hold of someone again. Weeks would just pass where she did not know what was happening. And then people with higher-grade cancers, people who are in palliative, for example, when you don't have that information from an oncologist,

from that first consultation from an oncologist, you don't have the information to make some very important life decisions. So I was talking to Amy Tan, she's a palliative care physician in Victoria. She was saying that in a normal year, she would spend about 80% of her time with patients and their families trying to decide what they would do at the end of life. You know, are we going to try a clinical trial that could potentially extend your life or improve the quality of your life? Would you want to consider palliative chemotherapy? But without that first consult, you don't have any of that information.

And so patients are just left waiting. So another family doctor that I spoke with on Salt Spring Island, he told me about a patient who was in his 70s, who was diagnosed this past June with metastatic cholangiocarcinoma, which is also called bile duct cancer. He was a recently retired farmer and carpenter. He was otherwise healthy. He was still active when he was diagnosed and he was working in his yard. And he waited three months for a first consultation with an oncologist. And by that time, his disease had progressed to the point that he couldn't move on his own. And he was definitely too weak to leave Salt Spring Island for treatment in Victoria. And he went ahead with medical assistance and dying a few days after that first consultation. Oh, my God. Wow.

So these are pretty devastating stories, honestly, Andrea. I want to ask you about the context of this, though, because we've been hearing for months now, with the pandemic especially, we know that our health care systems across the country have been strained. But let's put these delays, I guess, into that context. How do patient experiences in B.C. compare to other provinces in Canada?

Yeah, so a big challenge in presenting a clear picture of what's happening in BC is that the government does not make wait time data publicly available. So we had to go and speak with oncologists and other people working within the system who would essentially send screen grabs of wait times for us to piece together what was happening and what has happened over time. So this fall, less than 20% of cancer patients who were referred to an oncologist were able to see them for a first consultation within two weeks. That's the recommended time frame. And that's in BC then? Yes, that's in British Columbia. And compared to Ontario, 75% of patients are able to get that first consult in two weeks.

After a first consult, roughly half of cancer patients will require radiation. And in British Columbia, according to data from the Canadian Institute for Health Information, which is also called CHIHI, about 88% of people are able to begin radiation within the benchmark of four weeks, which makes BC the poorest performing province in a country where the national average is 97%. And I wonder too, because it sounds like a lot of this does come down to money, are these delays costly? Like if a patient can't get in to see someone right away,

do they end up costing the system more? Yes. So something that could have been a relatively straightforward surgical cure. If you had been able to get in, you know, within the recommended five, 10 days, that could have potentially been enough. But with every delay, your disease could progress, it could mean that you suddenly need chemotherapy or radiation that you didn't need before. And that, of course, has a profound impact on the person and their health, but also to the system because it's very costly. So just help me understand what's happening here then, Andrea.

Why is BC lagging behind in getting people who are living with cancer fast access to the care that they actually need? So I spoke with dozens of people who are intimately familiar with what's happening in the system. This includes past presidents, oncologists either currently working in the system or had left the system, nurses, radiologists, patients. And what they're saying is that while the pandemic certainly exacerbated pressures on all healthcare, what we're seeing in cancer care in BC is the effect of decisions that were made years ago. So the past presidents, I spoke with four, sorry, this is past presidents of the BC Cancer Agency. They all attributed our

current challenges to governance issues stemming from when BC Cancer was moved under the purview of what was then the newly created Provincial Health Services Authority in 2001. So one of the past presidents, he said that before BC Cancer had its own board of directors and a direct line to BC's ministry and minister of health, that they invested heavily in recruiting nationally and internationally, spent a lot of money on emerging technologies and sciences. And he said that they had a level of freedom to exercise strategic decision about how the agency should be run. The past presidents say that after moving under the umbrella of PHSA, there was a whole shift away from medicine and science leading into the future to budget management to make the medicine fit with the budget. We'll be right back.

What about the impact on staff, on medical professionals who are actually providing this care? A few months before the pandemic started, there was a national survey of oncology physicians that found that BC cancer oncologists self-reported the highest levels of disengagement and burnout among oncologists across Canada. They said that there were not enough physicians to meet workload demand. There was not enough time to complete administrative tasks. They described their work atmosphere as hectic and chaotic. And the human impact becomes very apparent when you talk to these oncologists. Sarah Finlayson, who is the division head of gynecologic oncology at the University of BC, she said she's experiencing a career high level of moral distress. She mentioned, for example, say there are three patients booked for today, but we only have space

for two now. Do we choose the 43-year-old mother of two, or do we pick the 65-year-old woman who traveled a long distance to be here? She never used to have to make decisions like that, or they would be incredibly rare. Whereas now she says she's making decisions like that almost every day, and she's wracked with feelings of shame and guilt for being the person to decide that. One oncologist wrote and said that when you're a physician, your career and the level of care you provide becomes such a big part of your identity. And the feeling of not being able to fulfill that and to do that well has a very profound effect on them. Yeah. So we've talked about staffing issues, but I want to go back to the governance issues that you mentioned from a while ago.

What is that causing in terms of the actual effects we see in the system today that are the problem? Two past presidents sounded the alarm on capacity issues around a decade ago, the early 2010s, saying that the system was pretty much full then and that a big surge in cancer incidents was on the horizon because of our growing and aging population. None of this should have been a surprise, the president say. They said we would require huge investments in infrastructure and the hiring of specialists. One person laid this all out in a cancer plan and presented it to PHSA leadership. And they both said that they were essentially ignored. Three past presidents resigned early from what are normally five-year renewable terms. They left it two and three years.

And they said that their hands were tied and that they could not be effective at their jobs anymore. And you just mentioned the PHSA, which is, of course, the Provincial Health Services Authority. And so I guess the question is, why wasn't anything done? That is their question. They had been quite concerned about this. And when you build a new cancer center, for example, that's like a five or 10 year horizon. This is not something that can happen

in the next couple of years. So they were quite concerned that those actions weren't being taken. And some of them feel that now it's sort of a race against the clock. We have cancer centers planned. There are two that are supposed to open up in the next three or four years, I believe. And then there

are two in concept planning stages. But with what we had known about the projection of cancer incidents in BC, is that going to be enough? And is it going to be soon enough? Yeah. How has the BC government responded to your reporting on these delays, Andrea? So there are a couple of things. There's Dr. Kim Nguyen-Chi. He's the current head of BC Cancer. To his credit, he has been quite frank in acknowledging the pressures at BC Cancer. He said they're making efforts to hire aggressively. There's steep national and international competition in the

recruitment of skilled medical staff. He pointed out that it's an average eight to 12 months to hire a new oncologist. He acknowledged that we're not currently prepared for the projected increase in cancer cases, but he said he does believe that the projects underway, the cancer centers that I had mentioned, for example, the recruitment efforts, he believes that that will be enough to meet the need. BC Health Minister Adrian Dix,

he acknowledged the concerns from BC cancer staff and the past presidents about the governance structure, but he did not feel that that was the problem. He said the bigger issue is that we're just at a point of increasing demand owing to the province's growing and aging population and that we will address this with dramatic recruitment. But again, of course, when you talk to the past presidents, they say this wasn't a surprise. We knew about this for many years and we didn't effectively plan for it. And I guess the actions that are being taken now, the people that you're talking to, do they think that's going to be enough? So many of the solutions that are underway now and are needed are similar to other solutions that are being proposed for, say, the family doctor crisis here in BC. So we will probably have to address oncologist compensation, which I believe is the lowest in Canada in BC. And we have a very high cost of living, of course, in Vancouver.

We need more nurses because without them, surgical procedures can't proceed. Need more support staff to ease administrative burdens. So these are things that are being floated and some pieces of this are being worked on. But one of the past presidents that I spoke with said we are on a concerning trajectory right now, and he does not believe that these projects underway will meet that need in time. Wow. Just lastly here, Andrea, I want to come back to Lorraine Glover, who we talked about right off the top. What are her feelings around all of this? So she recently, I believe, finished her chemotherapy and she said she hated the entire process, but it appears that the worst is behind her now. But she said what gives her a lot of anxiety and worry is thinking about all the other people, the young people who will get cancer. And she thinks a lot about what will happen to them.

Andrea, thank you so much for your reporting and for speaking with me today. Thank you so much, Manika. That's it for today. I'm Manika Raman-Wilms. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Kasia Mihailovic is our senior producer, and Angela Pichenza is our executive editor. Thanks so much for listening,

and I'll talk to you tomorrow.