Connie Dallaire arrived in Toronto on Friday, March 20 for treatment at Princess Margaret Cancer Centre.
Ms. Dallaire, who lives in Thunder Bay and has liver cancer, was not scheduled to begin radiation therapy until April 1. But she came to Toronto early, worried that the novel coronavirus outbreak, which had already disrupted global travel networks, might make it difficult to book a flight if she waited any longer.
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Shortly after she arrived, Ms. Dallaire learned that her radiation treatment would be postponed indefinitely, as a result of Princess Margaret’s response to the pandemic.
On Wednesday, Ms. Dallaire was on her way back to Thunder Bay, disheartened and wondering why she hadn’t been given more warning that her treatment would be postponed.
“I phoned Toronto a few times, and I said, ‘Is everything a go?’ ” Ms. Dallaire said in a telephone interview.
“She [a clinic secretary] said as far as she knew everything was a go, so I came. And since then, everything’s been up in the air," Ms. Dallaire said.
Thousands of patients are facing similar uncertainty as hospitals across the country postpone surgeries and treatments to make space and staff available for a potential surge in COVID-19 patients. The measures are considered essential to prepare for the unfolding pandemic but also raise questions about how they will affect patient health and waiting times in the months and years to come.
All provinces and territories this month said they would be postponing elective procedures, citing the potential impact of COVID-19. Ontario announced the measure on March 15, with Health Minister Christine Elliott saying that the province had asked all hospitals to begin “carefully ramping down” elective surgeries and other “non-emergent clinical activity.”
B.C. took the same step the next day, announcing that elective surgeries would be cancelled. Other jurisdictions took similar measures around the same time.
The cancellations are nerve-racking for patients and health-care providers.
“It’s extremely upsetting to hear that some patients’ treatments may be delayed – that’s not what we signed up to do as physicians,” Dr. Mary Gospodarowicz, medical director of Princess Margaret Cancer Centre, said Wednesday in an interview.
“But our aim at Princess Margaret is to provide cancer treatment in a safe environment and treat as many patients as possible,” she added.
Princess Margaret is postponing treatment for patients where the evidence exists that the treatment can be safely put off for one or two months, including people with prostate and breast cancer, she said.
The process, undertaken under Ontario’s pandemic plan, aims to ensure that surgeries deemed critical are done as soon as possible, Dr. Gospodarowicz said. Ms. Dallaire said she was told, after she returned home, that her treatment was not considered critical.
The measures are designed to protect staff and cancer patients.
“Because coming to the [hospital] actually puts patients at risk to develop COVID-19 – and we know that cancer patients are more susceptible, we know that from experience in China and Italy," Dr. Gospodarowicz said.
"And we also know that cancer patients – who by virtue of the disease may be immune suppressed to various degrees – may run a more aggressive course of the disease and have higher rates of serious, severe complications.
“So this is to protect the patients – and having a balancing act,” she added.
Reached at her home in Thunder Bay Thursday, Ms. Dallaire said she’d received a call from the hospital, telling her it was prioritizing patients deemed critical and urging her to stay home for her own health’s sake. She hopes the hospital will reschedule soon.
As of Thursday, Ontario Health, working with provincial hospitals, had identified up to 1,599 hospital beds that could be made available as a result of the minister’s direction to ramp down elective surgeries, a ministry spokesperson said in an e-mail.
This week, B.C. Health Minister Adrian Dix said B.C.'s acute-care system – typically running at an average 103.5-per-cent capacity at this time of year – is now running at 66 per cent across the province, reflecting the cancellation of thousands of elective surgeries.
“Of all the decisions that have been made since the beginning of this [pandemic], this was one of the hardest,” Mr. Dix said at the province’s daily COVID-19 briefing on Thursday.
“We call them elective surgeries but as you know they are scheduled surgeries, and they’re all important, they’re all medically necessary,” he said.
One of those cancellations was a hip replacement for Vancouver resident Liz Fendley.
A retired general physician, Ms. Fendley had been scheduled for surgery in early April.
This month, she learned that her surgery would be cancelled, with no clear indication of when it might be rescheduled.
Ms. Fendley says she is in better shape than many awaiting surgery; she is not in significant pain, can walk unaided and has been in the hip-replacement queue for less than a year.
As well, as a former doctor, she understands the risks of infection.
“It’s a bad time to be in a hospital,” she said.
Ms. Fendley said her main concern was the long-term impact on waiting lists, saying she spent much of her time as a general physician trying to obtain timely care for patients who needed specialized treatment.
In Vancouver, privately owned Cambie Surgery closed in early March and offered its facilities and equipment at no cost to Vancouver Coastal Health, medical director Brian Day said.
Cancellations are a necessary precaution but will worsen existing waiting lists for surgeries, said Dr. Day, the lead plaintiff in a long-running legal challenge that seeks to overturn restrictions on private health care in B.C.
“What’s it going to look like when we get out of this?” Dr. Day asked, adding that there were thousands of people on surgical waiting lists before the pandemic began.
A 2019 report on waiting times by the Canadian Institute for Health Information said most Canadians continue to receive timely access to urgent procedures, such as hip fracture repair and radiation therapy, but that 30 per cent of patients who required a hip or knee replacement or cataract surgery did not have their procedure done within the recommended waiting times.
Mr. Dix said rescheduling cancelled surgeries would be a “huge priority” if circumstances change to make that possible.