No doctor is an island

The rate of cancer in the Canadian population is increasing, in part an unintended consequence of medical advances helping people live longer. The Canadian Cancer Society tells us “an estimated 206 200 new cases of cancer and 80 800 deaths from cancer will occur in Canada in 2017,” and that “about one in two Canadians will develop cancer in their lifetime and one in four will die of the disease.” However, while more people are getting cancer, more are surviving it as well. As a result, demographics of patients in community practices are changing and there are added challenges for primary care physicians.

The BC Cancer Agency (BCCA) is addressing these challenges by re-evaluating the Family Practice Oncology Network and assessing options for patient care in every BC community. Access to care and coordination of care are paramount.

I took the GP oncology training course several years ago. When I started in practice, cancer care and chemotherapy were part of our generalist repertoire and were commonly administered in rural communities. Drugs were shipped on the Greyhound bus and administered in the ER. Rural GPs managed the delivery and follow-up of chemo in our own towns, as well as the disposal of all biohazard waste. The process was straightforward, but as the complexity of treatment protocols exploded and worries about safe handling of medications increased, we found ourselves cut out of the loop. Without an on-site pharmacy, a particular biohazard fume hood, and a specially trained chemo nurse, we were no longer permitted to administer the medications. And while in the current risk-averse climate this change was justifiable and inevitable, it was also sad for our patients.

I have a personal interest in cancer care, as my mother died of a gastric cancer. And although she lived in a US city with every imaginable resource, her care was not well coordinated. I saw GP oncology training as a way to do better for my patients—a way to acquire additional skills that would benefit my community, even if we could not re-establish administering chemotherapy ourselves. Access to cancer care is particularly challenging for rural communities because of the need for multiple trips out of the community for diagnosis and treatment, and possibly to numerous communities at each stage of the illness. There are huge costs for the patient receiving treatment—financial, physical, and emotional. Patients may choose a specific treatment only or choose not to be treated at all because of the distances involved. It doesn’t help that appointment scheduling for diagnosis is limited by available resources and personnel. When MRI access is available only 1 week out of every month, or there is just one radiologist available to perform a CT-guided biopsy, or there isn’t sufficient staffing in recovery to monitor the patient with the lung biopsy, the ability to arrive at a speedy diagnosis is compromised.

My GP oncology training has helped me better coordinate and expedite diagnoses. I serve as a resource to my colleagues locally to help manage referrals to various specialists and to the BCCA, and linking with the nearest Community Oncology Network clinic has alleviated some of their workload as follow-up exams and survivorship care can now be done locally. As more oral chemotherapy drugs become available, this aspect of care can also be managed closer to home. Videoconferencing for early discussion of treatment planning and follow-up has been very successful and has reduced patient travel. Most important, the relationships established and mutual understanding have directly helped patient care both in and out of our local community. Communication between the primary care physician, the GP oncologist, and the oncologist is vital to better coordination and integration of cancer care across BC.

The BCCA has recognized the essential role primary care plays in developing a stronger network of care. It is developing a Provincial Primary Care Program within the BCCA, and is asking for input from all family physicians in BC and Yukon. A short online survey will be conducted this month to assess educational needs and develop a vision for this new, evolving program. The link will be mailed out or made available through http://ubccpd.ca/oncology, and I encourage my fellow GP/FP colleagues to participate—we need your input to get this right.

As we work to provide for our patients in this era of dwindling resources and inadequate capacity in the health care system, networks of care will be our opportunity to improve access and provide better care. There is much to be gained by leveraging each other’s strengths.
—Trina Larsen Soles, MD
Doctors of BC President