COVER

DELAYS AND CROWDED HALLS

NORA UNDERWOOD June 13 1988
COVER

DELAYS AND CROWDED HALLS

NORA UNDERWOOD June 13 1988

DELAYS AND CROWDED HALLS

COVER

In the heart of one of Toronto’s most heavily populated residential areas, Princess Margaret Hospital runs the largest cancer treatment centre in Canada. Inside the front doors there is a waiting area where about a dozen people flip through magazines as they wait for relatives or friends to finish outpatient treatment. But the calm of the quiet, beige-colored room disguises a harsh reality: an acute shortage of space, staff and equipment means that many of the 7,000 new patients admitted to the hospital each year will experience inevitable—and sometimes agonizing-delays in treatment. Refrigerators, medical equipment and trays of slides with tissue samples crowd the centre’s halls. There are only two lounges for patients’ family members, and researchers and their machinery are jammed into tiny laboratories on the hospital’s upper

floors. Said Dr. Raymond Bush, director of the overtaxed hospital which is attached to the Ontario Cancer Institute: “It’s pushed to the limit. We have to set priorities.”

Blame: That situation is repeated in many major Canadian cancer treatment centres. And many health-care experts blame insufficient provincial government funding for the lack of space, staff and equipment that frequently forces patients to wait weeks for treatment. As a result, many experts say that the time for fully developing a doctor-patient relationship—so critical to patients battling the disease—also suffers. And with a population whose average age is rising, the incidence of cancer in Canada is increasing. In Ontario alone, cancer rates have increased by more than 100 per cent compared to a population growth of about 35 per cent during the

past 20 years—and the demand for treatment, experts say, is only going to worsen. Declared Bush: “It is hard to find the energy, the time and the space to carry out the investigations, to be able to do more for the patients than you have done in the past.”

But that is already difficult to do in Toronto, Vancouver, Montreal and Winnipeg despite such much-needed relief as a $177-million rebuilding program that will vastly improve the Princess Margaret’s ability to care for cancer patients by the early 1990s. Meanwhile, at Montreal General Hospital, breast-cancer patients who require surgery routinely wait several weeks to get into the operating room. Hospital executive director Harvey Barkun said that provincial funding restraints had pared more than $3 million from the Montreal General’s overall operating costs during the past two

years. And earlier costcutting economies have sharply reduced the number of orderlies on staff there and at other Quebec hospitals. Declared Dr. Michael Thirlwell, the General’s director of medical oncology, the study of tumors: “There is a waiting list for people to get into the hospital. We can’t do breast biopsies when we want to because of crowded operating rooms. And people just aren’t getting in for surgery or chemotherapy as quickly as we would like.”

Anxiety: Despite such restrictions, cancer specialists in Montreal and elsewhere in Canada say that the waiting periods for treatment can often be reduced to one or two weeks in pressing cases. But, for a cancer victim, any delay can be difficult. Jacques Bruneau, 47, of Winnipeg, says that on two occasions during the past six months, a bed shortage |P at Winnipeg’s Concordia Hospital has prevented him from receiving treatment for lung cancer. Added Bruneau: “I go in once a month for three days to receive chemotherapy. I have to be on intravenous for four hours before I can get the treatment. And if they can’t get a bed for me, I have to go home and come back the next day.” Bruneau’s doctor has reassured him that a two-week wait for treatment poses no further danger to his health, but the electrical contractor said that the postponements are distressing. He added: “The anxiety of spending the morning there and then being told to go home— that is pretty rough.

Once I am there, I want to get it over with.”

Former Ontario Conservative MPP and MP Terrance O’Connor expressed similar sentiments. In February,

1987, his doctors found that O’Connor, then 46,

was suffering from rhabdomyo sarcoma—a rare form of bladder cancer that is most frequently found in children. Days later, he underwent surgery at an Oakville hospital to remove the tumor. Over a period of eight months, the lawyer received 56 chemotherapy treatments and 30 days of radiation at Princess Margaret. Now, his doctors say that O’Connor’s cancer is in remission. A member of the fundraising committee for the hospital’s proposed expansion, O’Connor recalled that one of the hardest parts of his battle with cancer was the delays in receiving treatment. “It was trying,” he said. “I began to intensely hate the chemotherapy. By the end of each week, I felt horribly sick. You want to get it done and over with. And because so much of cancer treatment and cancer cure is psychological, it helps if things run smoothly and treatments are on time.”

Since 1979, the 7,000 new patients whom Prince Margaret has been treating have been almost double the number for which the hospital was designed and equipped. Bush says that staff members try to maintain high levels of care. But frequently doctors say that they cannot always spend as much time with patients as they would like because there are only a few, heavily used examination rooms. As well, Bush noted that the hospital has only nine radiation therapy machines instead of the 16 that it needs. As a result, staff members are forced to operate that equipment 10 to 12 hours a day—a procedure that increases the

number of breakdowns. And Bush estimated that even after the new building is completed, the hospital would still be hard-pressed to accept more patients.

Nails: In Winnipeg as well, healthcare workers say that cancer treatment can barely keep up with the demand for care. Dr. Harvey Schipper, head of the cancer unit at St. Boniface Hospital, said that a new patient admitted for cancer treatment now has a good chance of spending hours lying on a stretcher in a hospital corridor as he waits his turn for treatment. Said Schipper: “We are hanging on by our nails. We lack cancer specialists, we lack the physicists, the nursing staff, the radiation equipment and the beds.” Currently, the provincial cancer foundation treats about 4,000 new patients a year. But, added Schipper: “We are seeing an eight-per-cent yearly increase in the number of new patients. It means there are long delays, jammed waiting rooms and shorter visits.”

Health care workers from coast to coast have similar stories. At the Newfoundland Cancer Clinic in St. John’s, director Dr. Alan Kwan said that the clinic was short of funds and personnel—and maintained high standards of care largely through the extra hard work of a dedicated staff. Even if the provincial government provided money for additional staff, Kwan added, there would be no room for them to work. In Vancouver, the Cancer Control Agency of British Columbia’s clinic is also running out of space, and treatment machines are running overtime—despite the fact that a $30-million building completed in 1984 now allows the clinic to treat 5,400 patients a year. Declared agency director Dr. David Klaassen: “We are concerned about a forecast 50-per-cent increase in the load of cancer patients by the year 2000 simply because of the demographics, the aging population and the baby boom.”

Burden: That is a concern shared by many Canadian cancer specialists. And most say that, for now, much of the burden rests on the shoulders of already-overworked staffs. Said Bush, who is a radiation expert: “The staff gets tired. And they also get frustrated because they have recognized the problem for so long.” Clearly, while many experts point to the expansion of some clinics, including Princess Margaret’s, as a step in the right direction, they predict that a greater effort is still needed as the population ages—and increasing numbers seek care at Canada’s crowded cancer centres.

-NORA UNDERWOOD with DEBORRA SCHUG in Vancouver, DOUG SMITH in Winnipeg, SHERRI WASILOW in Montreal and MAUDIE WHELAN in St. John’s