The first few breast cancer and prostate cancer patients started travelling from their homes in British Columbia to  receive radiation therapy at two clinics in Bellingham, Washinton, this  spring. They are part of a provincial government response to a growing  backlog of cancer treatment. The province announced its plan to send  patients to Washington state for cancer care last month.

As of June 13, the B.C.  Ministry of Health told The Tyee that two patients have started  receiving treatment at the private, non-profit PeaceHealth St. Joseph  Cancer Center and the private North Cascade Cancer Center in Bellingham.  Nine have had a consult with an American radiation oncologist. In  total, 87 patients in B.C. have been referred by the province to  American clinics so far, 38 of whom have accepted the referral and made  travel plans. 

“As you can appreciate, we are currently in  the infancy stages of this program,” B.C. Health Minister Adrian Dix  wrote in an emailed response to questions from The Tyee. 

“Patients with shorter treatment courses,  typically around five days, will be offered the opportunity for  treatment [in the U.S.],” Dix wrote. “Some patients choose to continue  care in B.C., or were not eligible to travel, or have a companion who  was not eligible to travel.”

Interview requests to  multiple oncologists with BC Cancer, meanwhile, were not answered by  press time. And the Health Ministry has asked U.S. doctors to refrain  from sharing information about the program with journalists. 

“We did get a request from  the Health Ministry of B.C. not to get into the details of things,” said  Dr. Alexei Polishchuk, a radiation oncologist at the North Cascade  centre. “We’ve been asked to direct media inquiries to the provincial  health authorities.” 

Similarly, a representative from  PeaceHealth St. Joseph declined to answer questions about their  agreement with B.C., instead stating they “prefer to have the  spokespeople for BC Cancer take the lead on responding,” in an emailed  response to The Tyee. 

Over the past few weeks, The Tyee has asked  questions of multiple people who have a stake in B.C.’s health and  cancer care system, from doctors and patients to researchers and  clinics. 

The  consensus is that while the plan to offload one part of cancer care for  breast and prostate cancer patients is a helpful, necessary step to  alleviate growing wait times for radiation therapy, it’s disappointing  because it doesn’t go far enough to address gaps and shortages in  diagnosis and treatment.

Though the ministry covers all expenses  for treatment, travel and a companion to accompany a patient while they  receive cancer care in the U.S., eligibility limitations and patients’  own requirements create some complexity in who can make use of the  program so far.  

The province initially estimated that under  this new initiative, up to 50 B.C. cancer patients could receive care  in Washington state each week over the next two years. At that rate, roughly 2,400 British Columbians with cancer could receive care south of the border per year. 

It’s an effort to address a provincewide demand for cancer care that is only projected to grow. This year, 33,105 people in B.C. are expected to receive a new cancer diagnosis. That number is expected to go up to 38,770 by 2029.

According to the B.C. Health Ministry, the  median wait time for radiation therapy in B.C. is 17 days as of May 24.  They also noted that wait times vary by cancer centre, region and  disease type. 

Meanwhile in these early days of B.C.  cancer patients being sent to Washington to address treatment backlogs, a  complicated picture of care is emerging. It raises questions about how  effective this initiative will be. 

A treatment option, but not a solution

In the three weeks since the Health  Ministry announced plans to refer B.C. residents for cancer care in  Washington state, no one from BC Cancer has reached out to Amber, a  terminal breast cancer patient in Vancouver, to inform her of new  treatment options. Amber is using a pseudonym to protect her privacy.

She requested to remain unnamed for two  reasons: as a gig worker she does not speak publicly about her terminal  cancer diagnosis for fear of losing work; and with BC Cancer as her only  choice for treatment, she fears repercussions in her care if named.

“I went for three mammograms  in my early 40s before the province changed the directive,” Amber told  The Tyee in a phone interview. “I stopped based on my family doctor  telling me to, and then at 48 I discovered a lump and it was already  stage three.” She is now 54 years old.

At the moment BC Cancer recommends  people get screened for breast cancer at 40 if they have a  “first-degree relative” (mother, daughter or sister) with breast cancer.  The current recommendation is people aged 50 to 74 without a family  history of breast cancer get a mammogram every two years. 

After a double mastectomy and the maximum  amount of radiation therapy possible in 2018, Amber’s cancer returned  three years later. She now has tumours in her neck, lungs, liver, spine  and brain, and needs radiation for pain management.

“If you treat breast cancer in an early  stage, it’s basically a 100 per cent chance that you’ll be fine,” she  said. “The more advanced it gets, the harder it becomes.” 

Amber joined some oncologists across Canada in calling for the country to recommend breast cancer screening start at age 40, following the U.S.’s lead. 

If Amber had been offered a chance to go to  the U.S. for any part of her radiation treatment, she would have  declined for multiple reasons. And those are not unique to her  situation. 

For one thing, Amber had let her passport  lapse during the pandemic, when travel was limited and renewing it was  not a priority, so she would not be eligible to travel. Secondly, there  is no one to accompany Amber to Washington. 

“Many cancer patients find that they lose  all their friends when they’re diagnosed because people don’t know how  to deal with death…. A lot of online cancer patient support groups that I  follow all talk about the same thing: how people disappear from their  lives,” she said. 

“It is really hard at first when it happens, but it’s just part of it.”

‘They know there’s this need they can’t meet’

The highly specific types of radiation  therapies being addressed by B.C.’s plan to send some patients for  treatment in Washington state is one piece of the diagnosis and  treatment puzzle. 

Doctors, patients and those who work with  cancer patients — researchers, support group leaders and ultrasound  specialists — are calling attention to a number of other pieces that  need addressing.

“Medical oncology has had excessively long  wait times. Particularly for GI [gastrointestinal] cancer, so colon  cancer, for example, and breast cancer,” said Dr. Jennifer Lush, a  family doctor in Victoria. “The medical oncologists are very stressed  because they know that there’s this need they can’t meet.” 

Dr. Lush has patients who were told they  should get immunotherapy for colon cancer within four weeks, but ended  up having to wait four months or longer. She has also had a breast  cancer patient who should have started hormone therapy within a couple  of months of diagnosis, but had yet to see a medical oncologist nine  months later. 

There is hope on the horizon that this  shortage of medical oncologists in Victoria will soon be addressed, with  the addition of two or three more specialists expected in the late  summer and fall, Dr. Lush said. 

Amber also drew attention to a shortage of  tertiary services. For example, she needs an MRI every three months to  monitor her tumours, but the last scan was months late. 

A shortage of family doctors, who are  needed to treat side effects of cancer treatments and screen for other  problems — like Amber’s arthritis, annual colon cancer screening, and  prescription medications to deal with other side effects — is also a  problem.

Leah Lariviere, the executive director of  Prostate Cancer Foundation BC, which offers emotional support services  for patients, said they have been hearing more and more from patients  who don’t have a family physician. 

“We’re not able to see a doctor,” “We can  only do it virtually,” “How can [they] diagnose me with this if it’s  only a [virtual visit]?” are some of the complaints they’ve been  hearing, she said.

‘Why would we think they have extra capacity?’

These problems won’t be solved by the province’s plan to open new cancer centres  in Kamloops, Nanaimo, Surrey and Burnaby, said Dr. Lush. “Why build  more expensive buildings that are going to sit empty?” she asked. “If  you take some of the people that would have worked in Victoria and you  move them up to Nanaimo, you’re not servicing either community well.”

This was echoed by Dr. Sanjiv Gandhi, a  pediatric cardiothoracic surgeon and former chief of cardiac surgery at  BC Children’s Hospital who quit at the end of 2022 to become the BC  Green Party’s second deputy leader. 

The model for health care provision in the  U.S. is different than in Canada which means due diligence is required  to make sure patients get the best care, Dr. Gandhi notes. 

“Having worked in the United States for 17  years, it’s not a thing to say ‘no’ to patients when you’re a private  hospital,” he said. “You always say ‘yes,’ because it’s a for-profit  business south of the border…. You can get the best treatment in the  best centres, but every centre doesn’t offer the best treatment.”

Both Dr. Gandhi and Dr. Michael Cox, a  senior researcher at the Vancouver Prostate Centre and associate  professor at UBC, wondered how and why B.C. selected the two for-profit  Bellingham clinics in Washington.

“Why would we think that [Bellingham  clinics] have extra capacity?” Dr. Cox asked. “I have colleagues all  over the world and none of them said, ‘We’ve got so much extra capacity  here.’”

Bellingham’s North Cascade Cancer Center,  which opened in April 2022, currently sees up to 35 patients a day,  according to Dr. Polishchuk. A representative from PeaceHealth St.  Joseph said their patient load varies depending on treatment cycles.  Both said they are happy to accept B.C. patients. 

“We currently provide radiation oncology  treatments and in the summer, we’re going to be adding medical oncology  treatment, primarily for now aimed at U.S. patients,” Dr. Polishchuk  said. 

The B.C. Ministry of Health did not answer The Tyee’s questions about how they selected the two cancer centres in Bellingham. 

While governments and health organizations  grapple with solutions for the future of cancer care, patients like  Amber keep moving through their daily lives, noticing how cancer has  altered them and their connections to meaningful communities and support  networks.

“I think there’s a perception that cancer patients have all these people around them supporting them,” she said.

By Brishti Basu, Local Journalism Initiative Reporter

Original Published on Jun 21, 2023 at 23:57

This item reprinted with permission from   The Tyee   Vancouver, British Columbia
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