Re: Deteriorating wait times for breast cancer patients

Issue: BCMJ, vol. 66, No. 9, November 2024, Pages 326-327 Letters
By: Liz Ewart, MD, FCFP

In their recent article “Deteriorating wait times for breast cancer patients at a regional hospital in BC, 2013 versus 2023” [BCMJ 2024;66:240-247], Hwang and colleagues nicely summarized the crisis in the breast cancer diagnosis and treatment system, not just in their regional centre, but also in all of British Columbia. In Kamloops, we established a rapid access breast clinic in 2017 in response to delays in the breast cancer diagnostic system. Our clinic has successfully decreased wait times from presentation to breast cancer diagnosis by an average of 21.3 days (mean 45.7 days prior to the clinic’s establishment and 24.4 days after its establishment),[1] and this could be used as a model of care for other centres.

The success of our rapid access breast clinic lies in coordination of care with diagnostic imaging, allowing patients a triple assessment on one day. This model schedules in a single appointment: (1) nurse and physician assessment, (2) breast diagnostic imaging and results, and (3) same-day ultrasound-guided core needle biopsy, if required. Additionally, our clinic acts as a hub for patients undertaking breast cancer diagnosis and treatment with a nurse navigator who coordinates care in our community. The clinic has been particularly beneficial for unattached patients and patients who have to travel to Kamloops from surrounding communities for investigations and care.

Despite improvements in the breast cancer diagnostic system, we continue to struggle to meet benchmarks for breast cancer diagnosis to treatment timelines. I agree with Hwang and colleagues that these timelines could be improved by bettering the biomarker reporting system, improving operating room access for breast cancer surgeries, and recruiting more medical oncologists to our community.

The Kamloops cancer clinic is staffed by four medical oncologists (one very close to retirement) and the equivalent of 2.5 full-time equivalent general practitioners in oncology. We have been unsuccessful in recruiting oncologists to our centre, in large part due to the current model of care. Our centre is a Community Oncology Network site administered by our local health authority rather than by BC Cancer. We therefore lack the resources and supports that the regional BC Cancer centres have, and this has negatively impacted recruitment and retention of oncologists in our centre. If the Kamloops cancer clinic were to come under BC Cancer administration and receive the same funding, supports, and services as the regional BC Cancer centres, we would undoubtedly improve physician staffing at our centre and improve timelines to breast cancer treatment.

I appreciate the work Hwang and colleagues put into their article and hope it will engage health authorities and BC Cancer to improve the breast cancer diagnosis and treatment system for all patients in British Columbia.
—Liz Ewart, MD, FCFP
Kamloops

This letter was submitted in response to “Deteriorating wait times for breast cancer patients at a regional hospital in BC, 2013 versus 2023.” 

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References

1.    Ewart E, Barton A, Chen L, et al. Assurance of timely access to breast cancer diagnosis and treatment by a regional breast health clinic serving both urban and rural-remote communities. Curr Oncol 2023;30:1232-1242.

Liz Ewart, MD, FCFP. Re: Deteriorating wait times for breast cancer patients. BCMJ, Vol. 66, No. 9, November, 2024, Page(s) 326-327 - Letters.


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