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- December, 2001
Card 2001 on Cancer Care in Canada
"Canada is being overwhelmed
by cancer"December 13, 2001 - The Cancer Advocacy Coalition of Canada,
a watchdog organization that tells Canadians what is really happening
to our cancer system, has released its Cancer Care in Canada, Report
Card for 2001 and the statistics are disturbing. Waiting Times
Based on a survey of
all provinces, Canadians diagnosed with cancer will have different
waiting times, access to treatment and survival rates, depending on
where they live.
- For the 12 months ending August
2001, the waiting time for radiation therapy ranged from 19 days
in Manitoba to 47 days in Ontario and anywhere from 21 to 49 days
in Alberta. British Columbia reports a median waiting time of
21 days. The Canadian Association of Radiation Oncologists recommends
that radiation therapy should begin within four weeks of referral
to the specialist.
- Ontario estimates that in the
12 month period surveyed, the number of patients treated within
the recommended four weeks ranged from 28 percent to 35 percent,
while 40 percent of patients waited more than eight weeks from
referral to the start of radiation therapy.
- Waiting times to begin chemotherapy,
from the date of referral to the oncologist to the start of treatment,
are highest in Newfoundland at 60 days and lowest in British Columbia
at 15 days, with Ontario reporting 34 days and Alberta reporting
Dr. Denis Roy, CEO of
the Quebec Provincial Fight Against Cancer, says the delays from diagnosis
and referral to treatment "are of paramount importance because it
is at the very beginning of treatment that we can make a difference."
Again this year, the
BC Cancer Agency produced the best results for access to treatment
and survival rates, but even the best system in the country has its
problems. "Access to new drugs is more of a problem than wait times
for therapy," said Dr. Susan O Reilly, head of the Division of Medical
Oncology at the University of British Columbia and the BC Cancer Agency.
"We may soon be in a position where provinces can t afford to pay
for them and we will have to make some very tough decisions about
what drugs or treatments drop off the list."Shortage of professionals
The culprit in these
figures is a severe shortage of cancer care professionals in Canada,
including nurses, oncologists and radiation therapists.
- Patients in Atlantic Canada
wait the longest for an appointment with an oncologist up to two
months in Newfoundland.
- Prince Edward Island sends all
its cancer patients elsewhere for treatment and New Brunswick
s shortage means that many patients are sent to Maine.
- Manitoba is unable to deliver
new radiation therapies, such as brachytherapy for prostate cancer,
because of a shortage of radiation therapists.
Across Canada there
are not enough people working in cancer care to meet the demands of
patients. "The country doesn t understand the magnitude of the problem,"
said Dr. Bill Evans, Executive Vice President of Clinical Programs
at Cancer Care Ontario.
Dr. Brent Schacter,
President and CEO of Manitoba Cancer Care, believes "the greatest
challenge is the heavier burden of the growing incidence of cancer.
It creates problems in a number of areas. It changes the way we do
our work." With the incidence of cancer growing at three percent per
year, Canada does not have the professional resources to keep up.
Cancer spending by the
provinces also varies widely. The investment per person (dividing
cancer agency budgets by the provincial population in 2000) is an
indicator of waiting times and barriers to treatment.
These figures are for
the cancer agencies only, and do not include the cost of other services,
such as diagnosis, surgeries in community hospitals or home care visits.
Cancer agencies are responsible for research, education, prevention
programs, radiation and systemic therapy.
- The highest annual spending
occurs in Alberta and British Columbia (at $45 and $44 per person
- The lowest per capita spending
is in Newfoundland, at approximately $18 per year;
- Saskatchewan ($35) Nova Scotia
($31) and Manitoba ($30) are mid-range;
- Ontario spends approximately
$21 per person on cancer research, treatment and education per
year, barely beating Newfoundland for the smallest amount of per
- Quebec and New Brunswick do
not have organized cancer agencies and could not report on their
cancer care spending. PEI sends it cancer patients elsewhere for
Data collection by provinces
is so underdeveloped that only five provinces could report on survival
rates, only six have any information about waiting times for radiation
therapy or the interval between referral and the start of treatment.
Poor data collection means that Canadian organizations responsible
for cancer care do not know if they are delivering the care that people
The full report contains
more details on all these subjects, plus:
- the prevalence of cancer as
reported by six provinces (the others don t know);
- five and ten year survival rates
for the top four cancers (in the very few provinces that collect
- the priorities for improvement
identified by each province; and
- a special report on Cancer Care
Card 2000 on Cancer Care in Canada
Click here to view page 1 & 2 of the Report
Card: Part 1: The State of Cancer Care Today, and Cancer in
Canada Then & Now
Click here to view page 3 & 4 of the Report
Card: Part 2: Provincial Round-Up: What We Know About Cancer
in the Provinces
Click here to view page 5 & 6 of the Report
Card: Provincial Round-Up: What We Know About Cancer in the
Provinces and comments by Michael Decter (continued) and Part
3: Problems Attracting and Retaining Cancer Care Professionals
Click here to view page 7 & 8 of the Report
Card: Part 3: Problems Attracting and Retaining Cancer Care
Click here to view page 9 of the Report Card Part
3: Problems Attracting and Retaining Cancer Care Professionals (continued)
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Click here for the full interview
with noted oncologist Bill Hryniuk, the former director of the Hamilton
Regional Cancer, who now practices in Detroit.
CARD 2000 Summary
In an ideal world, cancer advocates would be able to assess
the performance of different facets of the cancer care system and
clearly identify gaps in care that need to be addressed. We would
be able to see which provinces were getting the best (and worst)
results and direct our efforts to raising performance to an acceptable
standard across the board. We don't live in that world. As Michael
Decter says, 'Accountability for and comparisons of health system
performance will only be possible once every province is collecting
the same data and using the same definitions.' Right now they're
not. And that makes information itself the accuracy of information,
transparency of information, and comparability of information an
issue that advocates must address. We are assured that efforts are
underway to improve information gathering and dissemination, through
CIHI and Statistics Canada. Let's make sure that happens.
WHAT WE DO KNOW
Despite the 30-year-old war on cancer, improvements in our ability
to treat cancer effectively once a person is diagnosed remain localized
and small. Using National Cancer Institute data to trace the incidence
and mortality from the four leading cancer killers over 30 years,
we see no improvement in treating lung cancer, a small gain in survival
from colorectal cancer and, in breast and prostate cancers, small
survival improvements in the face of soaring incidence. Few provinces
can state how many of their residents are currently living with
a cancer diagnosis, a number which would do much to accurately assess
resource needs in the population. Survival rates for various cancers
do appear to differ somewhat between provinces, but until the definitions
and data collection and analysis methods are standardized, no firm
conclusions can be drawn.
We know anecdotally that people are waiting too long for cancer
treatments, especially radiation therapy, but provinces are only
beginning (and unevenly at that) to track waiting times. We do know
that the standard of care set by the Canadian Association of Radiation
Oncologists a four week maximum wait between referral to a radiation
oncologist and first treatment) is met for only 40% of Ontario patients
and between 32% and 62% of British Columbia patients.
Canada faces a serious and growing shortage of cancer care professionals
that poses a significant threat to the quality of care patients
receive. 'We are seeing regular, repetitive and serious deficiencies
in the cancer workforce,' according to Dr. Andrew Padmos, head of
the QEII Health Sciences Centre Cancer Program in Nova Scotia. Cancer
care professionals themselves report that patient care is suffering
as a result of shortages. Provincial cancer agencies have, to date,
engaged in aggressive recruiting from other provinces as well as
internationally, which only intensifies problems in some parts of
the country. Representatives of every professional group, from radiation
therapists to radiation and medical oncologists, radiologists and
oncology nurses, point to a need for a national human resources
strategy that takes a long-term view and a multi-departmental approach.
Education and Immigration policies must be made to serve the overall
cause of assuring a stable and sufficient supply of professionals.
Cooperation, between provinces, between professional associations,
and between ministries, is needed.