Susan is a 49-year-old accountant who lives in Scarborough, Toronto. She is married with two children. A firm believer in breast self-examination, she discovered a lump in her left breast earlier this year.
Her family physician referred her for a mammogram, which revealed the presence of a suspicious lump. Follow-up tests, including a core biopsy of the lump, confirmed a diagnosis of breast cancer.
Within two weeks of diagnosis, Susan had surgery at Toronto's Sunnybrook and Women's College Health Science Centre, one of the city's premier cancer treatment facilities. She had agreed with the treating doctors to have a lumpectomy rather than a full mastectomy, followed by post-operative chemotherapy and radiotherapy.
Susan had to wait eight weeks for radiation therapy; she found the delay unsettling. Chemotherapy was administered more quickly at Cancer Care Ontario's Regional Cancer Centre, a new facility, built on the Sunnybrook Hospital campus.
She has made a full recovery and takes the drug tamoxifen, which has been proven to help to prevent breast cancer recurrence. She will have annual follow-up, including a mammogram, at the Cancer Care Centre.
Dr Carol Sawka, a medical oncologist and administrator at Sunnybrook's cancer facility admits that delays for radiation and chemotherapy are a cause for concern. At present, her unit is the main radiotherapy service provider in the Toronto area, which has a population of 4.6 million. Cancer Care Ontario is building two more cancer centres, which should be operational by 2003.
For two years, Dr Sawka and her colleagues were forced to refer some patients to the US in order to stay within radiation treatment guidelines for people with cancer. The Canadian Association of Radiation Oncologists recommends treatment take place within four weeks of referral. At one point, two-thirds of patients were not meeting this threshold.
Waiting times for cancer surgery are also beginning to deteriorate. Research in an August edition of the Canadian Medical Association Journal shows an average waiting time of 37 days from diagnosis of breast cancer to surgery. This compares with a maximum waiting time of 14 days recommended by the Canadian Society of Surgical Oncology.
Until May 2001, 20 patients a week from Ontario travelled to centres in the US for radiotherapy. Since then, some cancer patients have received radiation treatment from a newly formed company - Canadian Radiation Oncology Services (CROS). In a radical move for Canadian health services, the private company - which is headed by radiation oncologist Dr Tom McGowan - leases the facilities at Cancer Care Ontario for evening and weekend clinics. CROS treated 6.5 per cent of Cancer Care Ontario's patients in August, which was all paid for by Medicare.
Critics have complained about the private medical nature of McGowan's initiative. He acknowledges these concerns, but points out that his administratively lean and clinically efficient company does not require patients to pay out of their own pockets. He sees scope for expansion into other capital-intensive and procedure-based areas of medicine. "You need a lot of physician cultural change to do this - doctors must lose their need for 'leadism' and embrace multiple clinical roles."
Series continues next week. See below.