Oncology shortages leading to hard choices for Alberta doctors

Article content

Demand is up for Alberta cancer treatment and serious, sometimes life-altering, delays are leading to the kind of triage that wouldn’t make sense in an ER.

“The patients that are thought to have the greatest benefit from treatments are being put at the front of the list, whereas patients who may not have as much benefit from treatment may never be seen,” said Dr. Brock Debenham, a radiation oncologist at the Cross Cancer Institute in Edmonton for 11 years.

Advertisement 2

Article content

“I’ve never seen it so bad, with the wait times for patients to be seen. I have seen patients who have undergone massive surgeries, and then we’re supposed to start radiation within four to six weeks after. And right now, we can’t even see them until two months after. I’ve had patients when they come in, the tumour is already back.”

With some fast-moving gastrointestinal cancers, up against treatment delays, things can go from curable to treatable to palliative, one downward spiral at a time.

“There are some patients that will never see an oncologist because they triage patients that they think will have the biggest benefit of chemotherapy — they will get triaged to be seen first. They may get put at the end of the list, and they may never see oncologists, because unfortunately they’re going to pass away before they get to that point,” Debenham said.

In an emergency room, a person who comes in with a heart attack will be seen more quickly than the one with the broken wrist, because they in more dire shape — even if their odds of survival are lower.

“It’s just completely unacceptable to have patients waiting three to four months to be seen. This makes no sense at all,” Debenham said.

Article content

Advertisement 3

Article content

A new plan has Calgary cancer patients going to Red Deer to be seen by Edmonton radiation oncologists, to try and reduce wait lists.

Growth has its complications

Over the last fiscal year — March 2023-2024 — across Alberta, between radiation, medical, and pediatric oncologists, there was only a (single) 0.5 new position added when oncologists leaving and retiring is accounted for, he said.

Alberta’s population is growing by the equivalent of one Red Deer each year.

In 10 years, the number of oncologists in Alberta rose to 122 from 102, as the number of cancer cases rose to 23,000, from 16,000.

Improved treatments, options, and outcomes means the 23,000 require twice the treatments they would have in 2014.

More patients need more courses of treatments, so more workflow for doctors and everyone who helps care for the patient in the cancer system, and more treatment space, which Calgary is getting in its new cancer centre and which Edmonton’s Cross Cancer centre is out of.

Alberta has the lowest number of oncologists per capita across Canada, Debenham said.

Estimates from the physician side for the needed number of net, new oncology posts to keep up with population growth and treatment success in Alberta range from 30 to 50.

Advertisement 4

Article content

Recommended from Editorial

Last year’s two new radiation grads took jobs in the United States.

Calgary had a radiation oncologist hired on in the next couple of months, but they’ve backed out of that job and taken a job in Ottawa, because it pays much better than Alberta does.

A Red Deer oncologist is moving to B.C. Their exit represents a 33 per cent loss, as there are only three there.

There seems to be circular logic at work.

The president of the Alberta Medical Association suspects over-optimism.

“I suspect that (the province) were trying to be optimistic in saying that they’re being competitive, being able to recruit, but actually, in reality, what we’re seeing now, B.C. and Ontario really actively recruiting oncologists,” said Dr. Paul Parks.

“We really do not think that AHS and the government understand how dire our recruitment situation is right now.”

Provincial response

Ensuring Albertans have timely access to cancer care is a priority for AHS, and recruiting and retaining frontline health-care staff is a challenge nationally, said spokesperson Kerry Williamson.

Advertisement 5

Article content

“We are doing everything we can to recruit for positions throughout cancer care, including medical oncology, medical physics and radiation therapy,” he said.

Andrea Smith, a spokeswoman for Health Minister Adriana LaGrange, said Alberta Health isn’t limiting the creation of new oncology posts at Cancer Care Alberta.

“Alberta Health has not capped the creation of net new oncology posts, nor have we capped the oncology budget,” she said, citing line items in Budget 2024, such as $108.5 million for the Arthur J.E. Child Comprehensive Cancer Centre in Calgary, $25.82 million for cancer research and prevention, and an increase in overall budget for cancer drug support.

Work is currently underway between the AMA and AHS on a master agreement for oncologists, Smith said. 

On May 22 in the legislature, LaGrange, an eye cancer survivor, cited College of Physicians and Surgeons of Alberta figures that note a growth from 107 to 142 oncologists between 2015 and 2024.

The CPSA numbers refer to licences held, not practising full-time physicians.

“Currently we have 17.2 FTE cancer Alberta physicians that have been recruited, with various start dates, and we’re going to recruit more,” she said.

NDP health critic Dr. Luanne Metz responded that 17 oncologists were recruited over the past five years, and most of those replaced others.

“We actually have only five more oncologists than we had in 2018, and most of them are not here yet. Given that the Alberta population has increased by at least nine per cent during this period, that is not enough,” Metz said.

LaGrange pledged to work with the universities to put out more oncologists, citing Cancer Care Alberta’s website showing just 4.9 vacancies.

[email protected]

Article content