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For Stedman Brophy to obtain timely radiation treatment for his prostate cancer, he had to leave the comforts of his Newfoundland home, travel about 2,500 kilometres and live in Toronto for eight weeks.

The 73-year-old is one of an estimated 400 patients expected to be sent to Canada's biggest cancer centre, Princess Margaret Hospital, in an effort to deal with a workload that has pushed the eastern province over the treatment brink.

"I would rather be treated in St. John's where my two daughters are," said Mr. Brophy, who lives in Daniel's Harbour, a small town in northwest Newfoundland. ". . . But I'm here and it's as good as it can be."

That province initially tried to deal with the treatment backlog by extending its work days to 12 hours, five days a week. But that resulted in breakdowns on its two machines, said Pradip Ganguly, head of radiation oncology for Eastern Health, the largest integrated health network in Newfoundland and Labrador.

"We made a proposal to the government, that if we don't do something, a crisis will be there," Dr. Ganguly said in a telephone interview from St. John's. ". . . For the sake of our cancer patients, we should send them out for timely treatment."

Although Eastern Health has financing approval for two more linear accelerator machines, it will take between 18 months and two years before they are operational because the cement bunkers to house them have yet to be built, said Sharon Smith, program director of the Cancer Care Program for Eastern Health.

"We would rather not have to do this," Ms. Smith said of sending patients to Toronto, something she expects to take place for the next 18 months to two years.

Radiation therapy is used in breast cancer patients to kill any remaining abnormal cells after surgery. For prostate cancer patients, it is used to eradicate the tumour.

The Canadian Association of Radiation Oncologists recommends patients be seen by a radiation oncologist within two weeks of being referred to one. Those same patients should start treatment within two weeks after that referral, making for a maximum four-week wait.

Newfoundland patients being asked to make the trip to Toronto are under age 75, with breast or prostate cancer, and no dependants. They can bring a spouse or friend; meals, accommodation and transportation are covered in what is expected to cost roughly $6,000 per prostate cancer patient. The price is lower for breast cancer patients due to the shorter treatment time, said Ms. Smith. Treatment costs are not included in that figure.

Peter Dawe, executive director of the Canadian Cancer Society's Newfoundland and Labrador division, said he is pleased the provincial government is ensuring patients get timely care. However, he is concerned that the treatment backlog occurred in the first place.

"One would think that something as basic as radiation treatment, that there would be long-term planning in place to make sure that even if you did have a blip in demand, you'd be able to accommodate it," Mr. Dawe said in a telephone interview from St. John's. ". . . The blip put them over the edge."

Blip or not, this isn't the first time Canadian patients have had to travel great distances for radiation treatment.

Newfoundland sent patients to Cleveland in 1999 when there was a shortage of radiation therapists. Similar shortages in 2000 forced New Brunswick patients to Maine, Manitoba patients to North Dakota and Quebec patients to Vermont, Maine and New York.

Ontario had problems providing timely radiation treatment twice: in 1993, when it had to send its Toronto patients to the northern part of the province, and in 1999, when it sent patients to the United States. A decade ago, British Columbia sent patients to Washington State.

In Newfoundland's case, Dr. Ganguly said the workload last year grew by 18 per cent, which was partly explained by an increased number of patients and also the types of patients being seen. Head and neck cancer patients, for example, take more time to treat.

When it was apparent the province could not provide timely treatment, an e-mail request was sent to every cancer agency in the country, asking for help.

In the end, an arrangement was struck with Princess Margaret Hospital, which has the largest radiation facility in the Western world under one roof, with some 19 machines. The hospital has agreed to treat as many as 20 patients per month. So far, 16 patients from Newfoundland have been treated.

"We see ourselves as a national resource, not just a Toronto resource," Dr. Padraig Warde, deputy head of radiation medicine program at Princess Margaret, said in a telephone interview. "We felt it was kind of our duty to help."

One patient who felt particularly grateful was Charmayne Davis, a 58-year-old nurse educator from Corner Brook, who underwent breast-conserving surgery in her home province.

She came to Toronto with her husband, Jerome Davis, a family doctor, somewhat concerned she had lost part of her support system of friends and family back home.

She flew home late last month, following 16 radiation treatments spread over four weeks. Her stay, she said, was nothing short of wonderful.

"There was a real buddy system that developed, it was a real sorority," Mrs. Davis said of the fellow patients she met at Princess Margaret Hospital Lodge, which provides accommodation to cancer patients. "People aren't sitting around and depressed. This place is full of laughter."

Indeed, Mr. Brophy, who travelled with his wife, Effie, said he met many people from his province in the city. While he said he received excellent care in Toronto, he is looking forward to his last of 39 radiation treatments on July 17.

After that, he will head home, where he works on a dairy farm part time.

According to Mr. Dawe of the Canadian Cancer Society, patients are better off financially coming to Toronto than staying in their home province, where many have to travel to St. John's, home of the province's only two machines.

Although there is a hostel in St. John's, Mr. Dawe said it is not always available. As well, not everyone qualifies for provincial government travel assistance. Most patients pay for some travel and accommodation costs, with those from Labrador typically being several thousand dollars out of pocket, he said.

"We've got to do better than what we're doing now," Mr. Dawe said. "At some point, it's going to take more long-term planning to make us believe we won't see this happen again."