“Regardless of where somebody lives, we want to be able to get them [care] on time.”Kim Nguyen Chi
When 74-year-old Linda Kerr was diagnosed with breast cancer last January, her only option was to make the more than six-hour-drive from Cranbrook to Kelowna — an arduous winter journey even in the best of health.
Two trips, and $5,000 in travel, accommodation and meal expenses later, she is cancer-free, having undergone radiation treatment at the Sindi Hawkins BC Cancer centre in Kelowna.
“I had what I felt was very excellent treatment,” she says. “But the travelling there and back and everything else was brutal.”
Cancer patients like Kerr, who live outside Metro Vancouver and Vancouver Island, are no stranger to long trips and enormous expenses when it comes to accessing treatment.
Which is why many are eyeing with interest a recent announcement by the BC government that it will fly breast and prostate cancer patients to Washington State for radiation treatment, and cover all their expenses.
Cheaper to travel to US for cancer care
In some ways, it would be cheaper and easier for them to take the province up on the American option, versus driving hours, and spending thousands, for normal treatment. The American program even covers the cost of an accompanying caregiver.
“That really ticks me off,” said Kerr, of being out-of-pocket for her trip and now seeing an American program.
“Don’t get me wrong, these people who have cancer need immediate treatment, and if it’s the only place to go and get it, good on them. But we’re supposed to have one of the best medical systems in the world. And it’s really starting to fail us.”
Health Minister Adrian Dix announced the new cancer program this week, saying up to 50 people per week for the next two years will have the option of being sent to one of two clinics in Washington State for radiation treatment, with the province covering all travel, accommodation and food expenses.
A staffing shortage, and overwhelmed cancer system, has led to unacceptable wait times for those patients, said Dix. He said he felt strongly the province should purchase treatment spaces at private American centres in order to get British Columbians the timely radiation treatment they need, while at the same time the province works to hire more staff and buy more equipment to fix its own system.
“With this announcement, we can take immediate action to improve access to radiation treatment for people throughout BC, including those living in rural and remote areas,” said Dix.
But initial reaction in rural and remote BC was mostly confusion.
Travel costs not reimbursed for BC care
The Opposition BC United party accused the NDP government of providing “no clarity” on whether those who live in the North, Interior and Kootenays would have access, or have to travel hours to their regional cancer centre in Kelowna or Prince George first.
“We don’t get reimbursed for any of our travel costs, we don’t have a bus service like they do in the north, so we are just sort of left hung out to dry,” said Tom Shypitka, Kootenay East MLA.
“So when we see an announcement like this, I don’t know if it’s jealousy or anger or what — I mean, I’m happy for the people who are going to get treatment, but we just wonder where are we in the mix?”
The province does intend to fly people out of their home communities, wherever that may be, said Dr. Kim Nguyen Chi, an oncologist and BC Cancer’s chief medical officer.
“Anyone within the province would be eligible for this, so somebody from Prince George or Prince Rupert, we’d fly them down, we’d take care of all the arrangements, stay in a hotel for those five days receiving their treatments, and come back,” Dr. Chi said in an interview.
“Regardless of where somebody lives, we want to be able to get them on time and on schedule.”
Alberta won’t take BC patients
In some areas of the province, it would be faster for British Columbians to travel to Alberta for cancer care than it would to fly to Vancouver or Bellingham. But the B.C. government did not get a favourable response when it asked Alberta to purchase space in its cancer clinics.
“Alberta is not open for patients to come from B.C.,” said Dr. Chi.
“We also inquired about just patients from the far east of the province going there, and the answer was no.”
Alberta has been refusing non-emergency treatment for British Columbians, especially in the Kootenay region, for almost six years now. What initially appeared to be a dispute about provincial billing fees has now evolved into a lack of staff and capacity in Alberta’s hospitals as well.
B.C.’s 10-year, $440-million, cancer plan does have expanded financial supports for rural and remote patients accessing cancer treatment, as well as money to boost travel.
But Shypitka said it falls short of opening new cancer care services in communities like his.
“If you can’t provide the access, we’re being severed from Alberta, and the fact going to Victoria or Vancouver is 1,000 km and seven mountain passes away and in the winter is practically impossible, then you need to build the service back home,” he said.
Staff shortages cause delayed treatment… except in Kelowna
Dr. Chi said B.C. is short at least 50 radiation therapists just for its existing service, let alone expansion. “That’s our main limiting step right now,” he said.
Fewer than 80 per cent of BC cancer patients are currently getting treatment within the recommended four-week window after diagnosis — the lowest rate, by far, in Canada. That doesn’t include the long wait to see an oncologist for an initial diagnosis as well.
But Kelowna, which serves as the regional cancer centre for the Interior and Kootenays, has the best benchmarks of the six cancer centres in the province, with more than 90 per cent of patients being treated with radiation within the four-week window, said Dr. Chi.
“They are meeting their benchmarks, they’ve got the human resources, it’s not a problem there,” he said. “They have a very low vacancy rate in terms of positions for radiation therapists.”
Still, Kelowna’s multi-hour driving distance away from many communities does have a measurable effect on cancer care.
“If you live more than a couple of hours travel from a radiation centre, folks are less likely to get radiation,” said Dr. Chi. “It’s probably because they are choosing not to travel to receive that radiation therapy for whatever reasons and the distance in travel. That’s why access isn’t just about capacity, access is about geographical access.”
Shypitka said he hears it constantly from his constituents.
“It’s a real tragedy story, I’ve heard these talks around the dinner table that dad is not going to go for radiation treatment because it’s too far away, the costs are too high for them, and so they just don’t do it,” he said.
For Kerr, who is now diagnosed as cancer free, the news of the U.S. cancer program remains bittersweet. She has since moved to Alberta, where she will remain on chemotherapy drugs for the next five years.
“I can’t complain about the service I got in B.C.,” she said. “The only thing I can complain about is the cost.”