The coming cancer crunch

By Dr. Peter Craighead
For The Calgary Herald — March 18, 2010

Publicly funded health care is only sustainable by focusing on and providing what is needed by its constituents.

During the boom years, many Albertans and their health-care leaders assumed we could ask for whatever we wanted. The truth is that Alberta’s health-care system now is forced to balance the needs of our public against the wants of its health-care leaders, whether this is in the provision of surgical services for joint replacement, caring for stroke patients or funding expensive cancer treatment.

The Rolling Stones aptly describe this in their song: “You can’t always get what you want, but if you try sometime you just might find, you get what you need.” The recent flurry of discussions around a new cancer centre in Calgary forces us to ask whether this is a need or a want.

Almost one in two Albertans will develop cancer in their lifetime, and one in four will die from this disease. Another way of looking at this is to realize that there were 14,500 new cancer cases diagnosed in 2009, and there are an estimated 80,000 people living with cancer in our province. About 85 per cent of these cancer patients will be seen and treated at cancer centres around the province. The Tom Baker Cancer Centre in Calgary is one of two major centres in the province, currently sees 150,000 patient visits annually and is the major referral centre for cancer care in southern Alberta.

So what is it that Albertans need when it comes to cancer care, and how has the system responded to this? Albertans with cancer need to receive state-of-the-art treatments in a timely, respectful manner; they should have access to care as close to home as possible; and they should not suffer pain or emotional distress. We also believe that Albertans should have access to prevention strategies that reduce the incidence of cancer and screening that finds the disease at an early, curable stage.

Until the second half of the last decade, Alberta’s health system responded well to these needs. For example, by the early 2000s the province had built up a network of facilities across the province, was highly responsive to cancer drug treatment requests and supported the purchase of expensive radiotherapy equipment in Edmonton and Calgary. Alberta was considered one of the best places to receive cancer treatment, and the place to work if you were a cancer specialist. This was evidenced by the successful recruitment of medical specialists, researchers, nurses and other professionals.

The rapid growth of Alberta’s population, continued increase in cancer numbers, success in recruitment and the change in our health system have all contributed to a growing capacity problem for us. Facilities in Edmonton and Calgary have outstripped their space, leading to a significant impact on patient experience. Cancer care has worked with the province to identify solutions, including the distribution of radiotherapy to smaller cities, plans to expand buildings in Edmonton and Calgary, and using leased space to tide us over for the medium term. We are also improving efficiencies within our centres to increase patient throughput.

The TBCC responded by moving some functions off site, because there was no available expansion space at Foothills Hospital. Since 2003, we have completed two phases of renovations in leased space at the Holy Cross Hospital, and the space we are currently renovating will allow us to expand treatment facilities at the Tom Baker site, so we can sustain our comprehensive service to cancer patients for southern Alberta for at least another three years. A few years ago, we also relocated many of the day procedures that we previously performed within the TBCC to the Foothills, but it is apparent that the rest of the system has minimal capacity to accommodate any further growth. Finally, we are in discussion with South Health Campus planners to see whether that space will provide us options for dealing with our space crunch in the medium term.

How have these decisions affected patient experience in Calgary? As I write this, patients experience serious overcrowding in our facilities, are made to travel between sites for various parts of their clinical care and some of them have excessive wait times to get in to see oncologists.

Fortunately, the wait times for treatment other than surgery continue to fall within our guidelines of two weeks for chemotherapy and eight weeks for radiotherapy. But the fragmentation of services into two sites means patients cannot take advantage of all services at one time. A further complication of providing clinical services across the city is that our clinical staff becomes less efficient by having to include transit times into their day. Simply put, distributing the services of one cancer centre within a city provides a suboptimal patient experience compared with full-service cancer centres.

Predictions tell us that by 2013, when the breathing room provided by Holy Cross will have been exhausted, we can expect to be seeing six to eight per cent more new cases, and to be treating 10 per cent more patients. Although the opening of Lethbridge radiotherapy facilities will help us deal especially with radiotherapy referrals, and the increase in throughput initiatives will gain some efficiencies in chemotherapy treatments, it is predicted that we will be facing severe shortages in Calgary by 2013. Given the budgetary pressures facing Alberta Health Services, it will take significant focus on our part to see a co-ordinated strategy for cancer in the next 12 months. The short-and medium-term solutions we have employed have allowed us to provide excellent care, albeit of a somewhat fragmented nature.

AHS has made efforts to respond to cancer patients’ needs in the short term, but we now must challenge ourselves to move away from a “building the new system” mode into focusing on how to address the longer-term needs of patients, including the particular needs of cancer patients in Calgary.

As a medical leader within AHS Cancer Care, I am ready to support any planning process that ensures that future patients in Calgary are provided a superior experience, and that we are able to address their need to receive timely, quality care.

Peter Craighead, MD FRCPC, is senior radiation oncologist and director of the Tom Baker Cancer Centre.

Read more: http://www.calgaryherald.com/health/coming+cancer+crunch/2695990/story.html#ixzz0iXuD3sPl

Lack of strategies to manage MRI wait lists a key reason for excessive wait times

By Jordanna Heller

A new study headed by Dr. Tom Feasby, Dean of UCalgary’s Faculty of Medicine, shows that while Canada lags behind other countries in the number of diagnostic imaging devices, more machines are not the only solution to long wait times. The study’s authors say it is critical to prioritize MRI (magnetic resonance imaging) requests effectively.

“This study shows there are important deficiencies in the current system. We hope this research will help health system decision-makers and managers improve the provision of this important service,” says Feasby, the senior author of “Management of MRI Wait Lists in Canada,” published in Healthcare Policy.

A MRI provides detailed images of the body, and is technology that is being used more frequently, especially in the areas of abdominal, pelvic, cardiac and breast imaging. The technology can be used to evaluate tumours, show abnormalities in the heart, brain and joints.

To determine how requests for MRI studies are managed the study’s authors surveyed public MRI facilities in Canada. Although almost all of the facilities have some methods to triage MRI requests, less than half documented their guidelines for prioritization, and none used quality assurance methods to ensure guidelines were followed. The report determined that despite wait times of up to several years in some facilities, strategies to reduce wait times are diverse, uncoordinated and largely ineffective.

Dr. Derek Emery, one of the report’s authors, says, “most MRI facilities in Canada have a substantial wait list problem. Improvement in wait list management will be necessary for better access, fairness and quality in the provision of MRI services in Canada. We do not currently know the extent of inappropriate overuse of MRI, nor do we know the extent of inappropriate underuse.” Emery is an Associate Professor in the Department of Radiology and Diagnostic Imaging at the University of Alberta.

“This paper shows that many MRI centres do not employ effective and standardized processes to track and manage the appropriateness of the scans they perform. Such processes are crucial to ensure that patients in different regions of Canada have equitable access to MRIs, and that patients who really do need an MRI get one rapidly. This is a challenging problem, and needs the focused attention not only of radiologists, but particularly the physicians who are ordering the scans,“ says Dr. Andreas Laupacis,  a general internist, the Executive Director of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto, and a professor in the Departments of Medicine and Health Policy Management and Evaluation at the University of Toronto.

This study was supported by the CIHR (Canadian Institutes of Health Research).

Full text of the study available here.

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