Random Access

When Dr. Terry Sullivan, the head of Cancer Care Ontario, comes calling at Credit Valley Hospital in his annual meeting with hospital staff, it’s a chance for the Province to lay out the big picture on cancer care to the locals: the trends, the plans, the problems and the improvements the provincial body would like to see.
Alternatively, it’s a chance for the doctors and administrators at CVH to give their feedback on how things are working/not working and how provincial initiatives actually track on the ground out here. And, of course, to provide the wish list for future equipment and funding.
After his visit to CVH last week, Dr. Sullivan and Dr. Sheldon Fine, chief of oncology at the hospital, talked about the state of the region for cancer care.
Here’s a quick-hit list of their concerns and comments, filed by subject:

• Breast Cancer: The Ontario cancer progress report that came out in January identified screening for this disease as a major issue. Across Ontario, only 56.4 per cent of women over 50 were screened for breast cancer last year. Sullivan said the numbers are down in Peel. The recent provincial budget aims to significantly boost screening. “We need to communicate better to our highly ethno-diverse population and to our family physicians,” commented Dr. Fine. “We have to make scheduling easier and report the results back quickly in simple, straightforward language.”

• Wait Times: “It’s important not to get sidetracked in all the political banter,” about the issue, said the former deputy minister of health and intergovernmental affairs. “I never met a surgeon or a hospital administrator who wants to be known as a poor performer. There has been constructive, competitive pressure through the posting of this data (on the Internet).” The Carlo Fidani Cancer Centre, which generally has below-average wait times because of high demand and limited beds, is “very sensitive” to the issue, Fine said. New operating room capacity has recently been added and CVH is planning an ambulatory off-site surgery centre as well. “We’re beginning to see wait times fall.” Bringing a fourth radiation unit on line next month will certainly help.

• Colorectal screening: As Sullivan noted, Dr. Fine has been a driving force in addressing the fact that Ontario has some of the highest rates of colon cancer anywhere (3,100 deaths last year). The new $193.5 million program for screening introduced in January includes a voluntary home-screening component that should increase early detection, which can save many, many lives. If you catch the disease at the beginning, “you have prevented the cancer,” Sullivan said. “This is one place where we can make big yards.” Adding colonoscopy capacity at hospitals is also in the works, with a goal of 10 per cent capacity growth in the next year.

• The smoking gun: “We’re making significant progress on the tobacco file through Smoke Free Ontario and it’s big,” said the Cancer Care President and CEO. Smoking rates have fallen below 20 per cent. If only things were as rosy on the rest of the lifestyle front. Still too many carbohydrates being scarfed down daily, not enough fruits and veggies and too little exercise.

• The Peel Perspective: New cancer centres opening in Newmarket, Barrie and Niagara will help take the pressure off here. CVH has pitched its case for installation of a fifth and sixth linear accelerator (radiation units) with the intent they come into use at the same time. The hospital wants the units sooner rather than later and they have a strong case, conceded Sullivan.
“Process innovation” doesn’t cost much and means better patient service, says Fine. Programs need to be housed where they make the most sense for the patient, not the hospitals. Patients should give their health history once and have it travel with them, not have to give it four or five times as they move from the clinic to imaging to chemo to the blood lab etc. Patients have to be assured of quality service no matter which facility they attend. “When you go on an airplane, you don’t have to worry about who the pilot is,” says Fine.

So how is Peel doing in its collaborative efforts to get all the agencies and hospitals on board in creating a unified regional model of health care?
“I think we’re in transition,” comes the guarded response from Sullivan. “Yes, there is some ‘institutional behaviour,’ some hiccups and some balls dropped.”