Patients Describe Their Experience with Waits

Killing time. Delays in treatment can be dangerous

In April 2010 I had a mammogram, only eleven months after a previous one. A biopsy showed that I had a grade 3 tumour (i.e., highly undifferentiated, with a high mitotic ratio) that had already grown to about 2 centimetres. Surgical removal was the obvious next step, but despite the efforts of my family doctor and friend, it was not possible to schedule the operation in less than a month, if not longer. As too often occurs in cases of backlog and delay, the specialist told me there was “lots of published evidence that it makes no difference whether it is removed right away or in two months from now.” I was in a daze.

But I work on breast cancer. There is plenty of published evidence showing the importance of early detection and treatment. If this were not so, why would the government pay for screening mammograms? Not all breast cancers are slow-growing, and even cancers that advance slowly at the outset, pick up speed as they progress and accumulate mutations. How quickly an invasion will kill is anybody’s guess at the time of the initial biopsy. So it is hard to be told to wait your turn as you wonder how quickly your cancer is spreading. I was told to “do yoga” to “deal with the stress of waiting.”

Luckily, I have a surgeon friend in Montreal who operated on me a few days later. I will be grateful to him forever. I had no idea how much the cancer had already spread, so I told my son farewell as I left for surgery. “If I do not see you again, I want you to become a good veterinarian.” My tumour turned out to be among the most aggressive. The whole tissue was cancer, a lobular, pleomorphic, and multicentric variant described in several publications as “particularly lethal,” fast-growing, and fast-invading. Luckily, my lymph nodes were still negative and PET, bone and CAT scans showed no metastases. But it would not have stayed put much longer, and once it reached the lymph nodes my life expectancy would have been, according to the literature, about one year. I have since had two more operations and six cycles of very aggressive chemotherapy, but the misery of these has been nothing compared to the fear of leaving my children behind as teenagers, 17 and 18.

I have friends who have had breast cancer in Germany, France, England, Poland, South Africa, and Greece. All, even with DCIS (ductal carcinoma in situ, a precancerous condition), had surgery within one to three days of the biopsy. All were told that it was critical to have surgery right away. Why are cancer patients in Canada told that waiting does not matter? Why take chances with patients’ lives? Cancer treatments are not “elective” or cosmetic, but are matters of death or life.

Greece is not a member of the G8 or G-whatever. Yet nobody in Greece is told when they are triaged to “be patient, meditate or go biking” as their cancer spreads. Canada is not a third-world country, but its standards in this matter do not compare with those of most civilised countries. It is not Canadian doctors, of course, who claim that delays caused by the under-funding of hospitals “make no difference”: it is Canadian politicians, Canadian economists, and ultimately Canadian voters, who vaguely imagine that by restricting the numbers of healthcare specialists we save some Canadian dollars. That policy would be unconscionable even if the calculus were valid. But the calculus is not valid, since allowing complications to develop is more costly in every sense of the word. Medical people, who know this so well, should never buy into the political excuse that delays in treatment “make no difference..”

© 2011Dr Leda Raptis. Used with the kind permission of the author.
Dr. Raptis is a professor at Queen’s University, cancer researcher and (hopefully) breast cancer survivor.