Card on Cancer Care in Canada
Why are top Canadian cancer specialists leaving?
(September 2000, Cancer Care in Canada)
Dr. Bill Hryniuk, a noted clinical oncologist, was director of the Hamilton Regional Cancer Centre and VP of the Ontario Cancer and Research Foundation (now Cancer Care Ontario). Now he's looking for cancer cures... in Detroit. Cancer Care in Canada's Susan Usher spoke with him in July 2000. Read his story and find out why cancer specialists are finding Canada a less attractive place to work.
'As director of the Hamilton Regional Cancer Centre and VP of Cancer Care Ontario (then called the Ontario Cancer and Research Foundation), I was responsible for administering cancer care for the Central-West region of Ontario and saw what the patients needed, from a standard care perspective. As a member of the advisory board to the National Cancer Institute in the US, Division of Cancer Treatment, I saw the direction that cancer research was taking, and the application of new technology and new knowledge to cancer treatment. Going back and forth like that, I could appreciate the increasing gap between Canada and the US in terms of what was possible. At the same time, I saw that the bureaucratic approach, of which I was a part, couldn't react effectively to the demands of the situation. I spent most of my time in Canada justifying why we had to take care of cancer patients to bureaucrats who were juggling those needs against the need to take care of sick children, fetal alcohol syndrome and elderly people with broken hips. The bureaucrats are not in a position to judge any of those things.
Many of Canada's problems result from not being oriented to the bottom line, which is care for the patient/customer. Rather, the customer in the Canadian government run system is the Minister of Health. In the customer-oriented American system, physicians know why we're there. We're there to make a living serving the needs of people. No question, patients come first.
This difference was really brought home to me one day was when the chief of radiation oncology in Hamilton came to me about a young man with Hodgkin's disease. He said: I was going to give him radiation but he had to wait too long because we didn't have enough machines, and now his tumour had expanded beyond my capacity to radiate. Can you give him some chemotherapy?
I realized that the disease had progressed to the point where he was no longer curable with radiation, and something snapped in me. We had worked so hard accommodating all the needs of all the emergencies confronting us, only to find that the effort was not enough. That day I realized it would never be enough; I was administering a system in which I no longer believed, so I couldn't stay on. I felt that I was administering a wrong system. When I got an offer from San Diego in 1992, I left.
I hear that the Minister of Health In Ontario has just approved an MRI scanner for the Hamilton cancer centre this week. It will still take another few years to get it up and working, which means that ten years after a need was recognized, it will finally be met. The day I arrived in San Diego in 1992, I had unlimited access to MRI scanners, but I had to learn how to use them. To take the approach of providing patients what they need 10 years after the fact is unconscionable, in my opinion.
The problem isn't with our doctors, or even our Ministries; it's with the attitudes of the Canadian people. When a journalist is writing about waiting lists growing long again, not one of the 1400 people on that list will talk about what it's like to wait for treatment. They won't complain. And that's the problem. Even as cancer patients are suffering from cancer untreated, people won't stand up and be counted and demand some answers. Unless the people of Canada change their minds about this approach, the government can't be expected to change.
Doctors have a gag rule imposed on them if they're working in cancer centres, because they can't tell patients about the newest treatments which they know are being tested and probably work because the director will come down on their head. In the U.S., the insurance companies tried to use gag rules, stating that if a treatment or maneuver wasn't covered by the company, then as a doctor under contract with the insurance company, you could not tell the insured patients about it, but it was struck down by the US courts last year. In Canada the gag rule applies, it just isn't on the books.
I am now part of a Detroit-based think tank plotting out how to get rid of breast cancer, prostate cancer, and lung cancer. That's my job, to get rid of these diseases. And in the US, I know that what I come up with can and will be put into practice. Right now, we're designing a machine that will diagnose pre-cancer and track the reversal of the pre-cancer process, which opens up a whole new set of possibilities for preventing cancer. The machine is being built with venture capital. In Canada, getting the money together would be difficult, and there isn't the same ability to bring together the needed brain power on the turn of a dime. The scientist who designed our machine also designed Star Wars and smart sensors.We've reached a stage where there is a confluence of technologies and pools of brain power with varied expertise that can bring in rapid advancement.
Patients in the US are different as well.They know the latest treatments, they're demanding, they keep us sharp. And as a physician, I fell that I can provide patients with prompter and better treatment in the US, and this has an impact on their outcomes.
Not surprisingly, the overall results of care are different Breast cancer mortality is lower in the US than in Canada.Cardiac mortality is lower.If you reach the age of 55 in the US, you will live longer than your Canadian counterparts.You can hide those numbers by treating the statistics in different ways, but they're solid numbers.
In conclusion, I belive a report card should be written on each of the provincial cancer agencies' results. But reports cannot, in all honesty, be written by the agencies themselves. Rather, a royal commission should be assembled to assume the reporting duties, at arms length from provincial and federal governments.