“Our clinicians are burning out and cannot sustain the current level of activity.”
A widening gap between cancer referral and cancer treatments is wreaking a measure of havoc in Alberta’s cancer care system, according to a recent report from Cancer Care Alberta.
The report, which was presented to the Alberta Health Services board in June, said waiting times for oncology and treatment have surged over the past seven years while the number of new cancer patients have also increased.
“We continue to struggle with wait times that are unacceptable and getting worse,” said Dr. Dean Ruether, medical director of community oncology for Alberta Health Services, in a letter to oncology colleague this week.
The report, which Ruether gave to AHS CEO Athana Mentzelopoulos in May, also points to factors affecting Alberta’s capacity for cancer treatment — complexity and chronicity of care, workforce and manpower resources, and capital infrastructure and equipment, the report indicated.
“Physicians continue to advocate for their patients, express concerns over the delays in getting patients into our system and to treatment and are sharing their own distress at watching this problem grow.
“Patient complaints about delays are increasing, to us and to Alberta Health and the health ministry,” Ruether stated.
The report comes at a time of an increasing growth trajectory in the province.
According to the province’s economic dashboard, with a quarterly upward change rate of more than one per cent, Alberta almost doubles the national average in population growth.
Delays by the numbers
New oncology referrals have climbed 18 per cent in seven years, mirroring growth in the “unique patient” category from more than 58,000 to almost 64,000.
However, the number of patients getting their first oncology consult outside the recommended window has escalated by 68 per cent, with the average rising to nine weeks from six weeks, a figure that took a startling jump in the months between the fourth quarter of 2023 to the first quarter of 2024.
The number of weeks from referral to first consult for radiological oncology has almost doubled, to 12.4 weeks from 6.7 weeks.
Waits from referral to first consult are shorter in smaller cities, with the Grande Prairie Cancer Centre and Margaret E. Yuill Cancer Centre in Medicine Hat at 6.1 and 6.7 weeks respectively — the closest to the provincial target of four weeks — and the Jack Ady Cancer Centre in Lethbridge at just over eight weeks.
Some 48 per cent of oncology patients are “out of window” in the referral-to-first consult category. That’s 9,016 patients. The majority are in the larger centres, with 3,929 of those at the Cross Cancer Institute in Edmonton and 3,836 at the Tom Baker Cancer Centre in Calgary.
Of the number of patients waiting more than four weeks for first consult, by tumour type, the top categories are genitourinary (including prostate cancer) at 2,193 patients, breast cancer at 1,958 patients, gastrointestinal at 901 patients, gynecological at 787 patients, lung at 659 patients and Heme (blood) at 619 patients.
Found that silver lining
Ruether also said that strong new treatment options that lead to longer outcomes for patients mean they need more ongoing care.
“Patients who 20 years ago may have been in our care for one to two years are now living longer and continue to require care through the cancer system, often for many years.
“Cancer is slowly being turned into a chronic disease. Many patients have access to multiple lines of therapy, sequenced over time,” Ruether said, citing multiple myeloma, HER2+ breast cancer, ovarian cancer, prostate cancer, lymphomas and lung cancer.
“An individual oncologist’s ability to take on more new patients is impacted by the chronicity of care that is required for patients already in their care. This trend will continue as treatments improve and patients have access to more options and lines of therapy.”
Why staffing matters
Oncologists are seeing significantly greater numbers of new patient consultations than is recommended (50 to 100 per cent more) and have been doing so for years, Ruether said.
“Our clinicians are burning out and cannot sustain the current level of activity.”
Timely access to care is critical to achieving optimal patient outcomes, including cure, prolongation of survival, and minimizing the burden on patients and families dealing with a cancer diagnosis, he said.
“A significant investment into the cancer system is required to address an increasing backlog of clinical care and stay abreast of the growing needs of Alberta’s cancer patient population.
“This will require a significant increase in the number of oncologists and the operational and infrastructure support for the needed increase in capacity to provide clinical care.”
Competition for oncology staffers is fierce between provinces. British Columbia upped the ante by building a series of cancer centres and a full-on recruiting program to match.
Meanwhile, in Alberta, a widening gap between how many positions are needed and how many are “open” (and funded) is a concern to Ruether.
Alberta Health Services sent Postmedia a statement Tuesday saying it is making efforts to fill positions.
“We are currently recruiting for positions throughout cancer care including oncologists, medical physics, nursing, and radiation therapy. Recruiting and retaining frontline health care staff is a challenge nationally, and not unique to Alberta,” said spokesman Kerry Williamson.
“Demand for cancer care has steadily increased year after year and we are working to address capacity pressures and improve access, including exploring options such as extending clinical hours to reduce wait times wherever possible.
“Additionally, while patients wait for treatment or to see an oncologist, Cancer Care Alberta offers patients with psychosocial support, community support groups, education, and supportive care services that can assist them.”