B.C. hospital increasing surgical capacity for gynecological cancers in response to long waiting times

B.C. gynecologic oncologists have been allocated more operating room time to clear a backlog that has women with urgent, high-grade cancers waiting up to four months for surgery, almost guaranteeing poor outcomes.

The Globe and Mail has been reporting on the pressures in cancer care in B.C., where insiders blame bureaucracy, poor long-term planning, staffing shortages and a ripple-effect in delays for pushing waiting times for treatment in many cases from weeks to months. All women on B.C.’s mainland with gynecologic cancers who are referred to such a specialist must travel to Vancouver, where 99 per cent of cases exceed benchmark waiting times, The Globe reported.

Vancouver Coastal Health officials met with gynecological surgeons in November and developed a plan to increase surgical capacity in coming months, according to B.C.’s Ministry of Health. By rescheduling a combination of unassigned time and extra time allotted for other services, the gynecologic oncology service at Vancouver General Hospital will have 21 additional days between Jan. 3 and March 10, equating to about 20 additional surgery hours per week.

Leaders at the hospital also committed to advocating for the expansion of gynecologic oncology services to other health authorities, said Sarah Finlayson, the division head of gynecologic oncology at the University of British Columbia and the gynecologic oncology representative at BC Cancer.

The Globe’s reporting “really got everyone to the table for the first time in a long time,” Dr. Finlayson said Tuesday. “I really feel like now we’re on a team of people who want to see this problem being solved, as opposed to being the only people advocating. After the data was shared and the article came out, I really felt like VGH leadership wanted to, and would, help us advocate for more gyne oncologists in B.C., in other locations.”

From April to June, just 4.7 per cent of patients with endometrial cancer on B.C.’s mainland were able to have surgery within the target time of eight weeks from diagnosis, The Globe reported in November. Only 3.9 per cent of patients with Grade 1 and 2 tumours were able to have surgery within the target time of six weeks from referral, while no patients with Grade 3 tumours were able to have surgery within the target time of four weeks from referral.

A cancer’s grade describes how abnormal its cells and tissue look compared with normal cells. Higher-grade cancers are faster growing and more likely to spread.

A lasting fix will require substantive changes. For example, Dr. Finlayson noted that a population of B.C.’s size should have 14 or 15 gynecologic oncologists, but it only has eight: six in Vancouver, and two on Vancouver Island.

“We know that the further away from Vancouver General Hospital that you live, the less likely that you will get what’s considered standard of care,” she said. “We know that women in the north and in the Interior don’t have the same access to gyne oncology that our patients in Vancouver Coastal and Fraser Health do. So there’s a volume problem, but there’s also an equity problem.”

As well, the increased surgical capacity is time-limited. The Ministry of Health said in a statement that it anticipates that the additional time will allow the department to catch up on the current backlog and return to normal operating room allocation beyond March 10, but Dr. Finlayson said that won’t be the case.

“It’s wonderful and needed, but that’s the amount of OR time we need if we’re not behind,” she said. “We’re dumping all of the cases that have been waiting since October into those slates. So I don’t know what to do with the woman I see next week, because the OR time is going to be completely filled with patients that have been waiting since the fall.”

Another short-term solution that was proposed was to operate on Saturdays – but a shortage of nursing staff rendered that impossible. Further complicating matters is the health authority’s transition from paper chart records to an electronic system, which has resulted in more cancelled surgeries as staff undergo training.

Delays allow cancers to progress. Whereas surgery may have been sufficient had a woman had timely care, a months-long delay may mean she now requires chemotherapy or radiation – or that the cancer has become incurable.

Dr. Finlayson also spoke of the moral distress that she and other oncologists felt not being able to provide the level of care they want to.

“Trying to choose, trying to decide who gets to go to the operating room – they’re impossible choices,” she said in an interview in September. “Say you have three cancer patients booked today but you can only do two. Do I choose the 43-year-old mother of two, or the 65-year-old who travelled a long distance?”

She said it was “extraordinarily rare” to have to make such decisions when she started in the role about 16 years ago, but that it is now almost an everyday occurrence.

Last week, Kelowna-Mission Liberal MLA Renee Merrifield stood in the legislature to deliver a private member’s statement on the growing waiting times for cancer treatment, citing the data and doctors’ accounts in The Globe’s recent reporting.

“Radical change is required,” Ms. Merrifield said. “We’ve heard the excuse for the increase in cases due to aging, but we were warned, and we all knew that this would happen. It could have been planned for, but it wasn’t. The increase in cases is not the reason. Failure to plan for capacity in a timely manner is the issue.”