breast cancer surgery wait times in ottawa are so long that women are heading to a private clinic in montreal
11 minute read
julie coulson fine, 50, had two lumpectomies and a full mastectomy in 2020 in montreal after she was given an indefinite wait time in ottawa for surgery following her breast cancer diagnosis. today she has a clean bill of health and thinks seeking out her own care at a private health clinic possibly saved her life.
julie oliver
/
postmedia
by the time lisa met with a breast cancer specialist last fall to discuss surgery, frustration and panic were setting in.
the ottawa woman had discovered a lump on her breast more than six weeks earlier. with no family doctor, she navigated the health system largely on her own before a biopsy confirmed she had an invasive form of cancer. it was still at an early stage, but had spread to her lymph nodes.
she wanted it out as quickly as possible before the cancer spread further. but when she met with a surgeon at the ottawa hospital in late october she was told the surgeon only had one date in december and she would not likely get in to surgery until january because there was so little operating room time available to breast cancer surgeons.
she heard from others that those surgery dates are sometimes pushed back further. she knew she couldn’t wait that long.
lisa, who is now retired from the canadian military, experienced abuse during her career there which contributed to her mental health struggles. this newspaper has agreed not to use her real name to protect her privacy.
“there was no way i was going to make it through the winter and christmas. i have mental health issues already. i knew i would go downhill really fast,” she said.
advertisement
the following week, she contacted vm-med montreal breast center, which describes itself as the largest private breast centre in canada. lisa had done her homework, including speaking with another ottawa woman who recently had surgery at the montreal clinic. lisa went for a consult a few days later, paid a deposit, and was in surgery 10 days after that.
lisa is one of a growing number of ottawa breast cancer patients who are turning to private surgery because the wait in the public system is so long. patients, support workers and the montreal clinic itself have confirmed the trend. a spokesperson for the clinic said they have seen an increase in patients coming from ottawa since last fall. patients who have gone to montreal for surgery share their experiences with others in breast cancer support groups. some patients are using a significant chunk of their savings to do so.
lisa paid about $50,000 for surgery. that included a double mastectomy, breast reconstruction, sentinel lymph node removal and follow-up. it is a figure she doesn’t share with many people. “most peoples’ chins would drop to the floor,” she said. a double mastectomy costs about $15,000 at the private clinic. a lumpectomy is less than $5,000.
advertisement
she was satisfied with both the speed and the quality of care she received and understands why other ottawa patients are also seeking private breast cancer surgery in montreal.
“word is getting out, obviously, because the wait is unacceptable.”
***
gail kelpin will have waited six months for breast cancer surgery when it takes place later this month. the ottawa hospital has some of the longest waits for breast cancer surgery in ontario.
jean levac
/
postmedia
as backlogs have grown in recent months, frustrated surgeons have begun mentioning private surgery as an option, patients say.
the mere suggestion from her surgeon stunned christine macmillan.
“i was shocked when they suggested private,” said macmillan. “this is our great canadian health care system?”
macmillan, 59, was diagnosed with early-stage breast cancer in october. she met with a surgeon at the ottawa hospital on nov. 7 and was told she would have surgery at the beginning of january. that date was later bumped back to early february.
the wait, she says, was torture.
for ottawa’s gail kelpin, the wait continues.
the 55-year-old will have waited about six months when she has surgery later this month — 24 weeks after meeting with a surgeon and a full 27 weeks after she was diagnosed with cancer. that is about double the target time designated by the province. prior to the pandemic, the wait for breast cancer surgery at the ottawa hospital was between eight and 10 weeks.
advertisement
during that period not one, but two, surgeons suggested she consider private surgery. one even suggested kelpin, who travels frequently for work, may need to go to another country.
“this is wrong for so many reasons,” said kelpin. not just because of the cost of private surgery, which most people could not afford, but she has other concerns. chief among them is what it means for the public health system.
under federal law, private clinics are not legally allowed to provide services covered by the canada health act. but there is a loophole that allows patients to go out of province for private surgery. the supreme court of canada recently decided it would not hear an appeal from vancouver-based physician dr. brian day who has been challenging the health care system for years over the right to access private care when the public system isn’t able to offer timely care, which is seen by some as a victory for public health care in canada.
critics have long argued that private clinics create a two-tiered system that makes it easier for the wealthy to get timely treatment.
kelpin didn’t want to have private surgery. nor did she want to jump the queue. but she is frustrated and angry. she worries about other patients who are less likely or able to speak up for themselves.
advertisement
“this has been six months of trying not to be stressed and trying to pretend it is ok,” she said. “this is supposed to be one of the pre-eminent breast cancer centres in the country. this is where we are at.”
***
dr. jean seely, a radiologist and researcher at the ottawa hospital, says the long waits for breast cancer surgeries could be fatal.
julie oliver
/
postmedia
the ottawa hospital has some of the longest waits for breast cancer surgery in the province.
ontario’s target wait times for surgery, after meeting with a surgeon, are 84 days for priority four patients, 28 days for priority three patients, and 14 days for priority two patients. the lower the priority number, the more advanced the cancer is and the more quickly patients have treatment.
in january 2023, only 13 per cent of patients at the ottawa hospital’s general campus went from a decision to have surgery, to surgery within the target time set by the province, according to data from ontario health. that means they waited significantly longer than a period deemed reasonable and safe by health officials. the provincial average is 71 per cent.
at the hospital’s civic campus, 21 per cent of breast cancer patients had surgery within the target time. at the riverside campus, that number was 55 per cent.
at queensway carleton, 95 per cent of patients go from a decision to have surgery to surgery within the target time. at montfort, that number is 50 per cent.
advertisement
the ottawa hospital says it is taking action — including developing a regional cancer strategy “to reduce overall wait times to ensure patients get care sooner and closer to home,” according to spokesperson rebecca abelson. the hospital has added more operating room time in april and may and is “exploring all opportunities to expand care capacity throughout the patient’s journey.” it is also developing a regional central intake system for screening, diagnosis and treatment that involves all regional hospitals.
the hospital is also working with the ministry of health to build surgical capacity.
it is not just breast cancer patients who are in long queues. wait times for all surgeries have grown during the pandemic, including a record number of so-called “long-waiters”, according to the province’s financial accountability officer. recent research from the canadian institute of health information found that waits for joint surgery grew during the pandemic, as did waits for breast, bladder, colorectal, lung and prostate cancer surgeries.
surgical wait times in ontario are divided into two parts: the first is the period from referral to an initial appointment with a clinician. ninety per cent of patients at the ottawa hospital’s general campus are seen within the provincial target time for the first wait. it is at the surgical stage that things break down to an extent not seen at other major hospitals around the province.
advertisement
the waits can have deadly consequences, said dr. jean seely, who heads the breast imaging section at the ottawa hospital and is the regional breast imaging lead for the ontario breast screening program.
“this is taking a heavy toll on patients, affecting their well-being and physical health. some patients have been waiting since oct. 2022 with a diagnosis of breast cancer and have not yet been surgically treated. these delays will have an impact on significant loss of lives to breast cancer until they are addressed,” she said.
research published in the british medical journal in 2020 found that the risk of death to breast cancer patients increases by six to eight per cent for every four weeks their surgery is delayed. another study published in the journal bmc surgery in november 2022 found that a delay in breast cancer surgery of more than eight weeks was inversely associated with survival for all patients.
those findings are frighteningly relevant for patients at the ottawa hospital. “there are currently unprecedented wait times for breast cancer surgery at the ottawa hospital,” said seely.
the hospital, in a statement, acknowledged that wait times for breast cancer surgery are growing.
advertisement
“we know this has been a very frustrating time for patients whose surgeries were rescheduled, or who have had to wait longer than anticipated,” said abelson.
***
vm-med clinic on sherbrooke and guy on monday april 10, 2023.
pierre obendrauf
/
postmedia
when the ottawa hospital began renting its operating rooms at the riverside campus earlier this year to a private company to perform hip and knee operations on saturdays, many breast cancer patients asked why their surgeries couldn’t also be done outside of standard monday to friday daytime hours to reduce the backlog.
“i would have gone in at midnight,” said macmillan.
wait times for orthopedic surgeries in ottawa are also above provincial averages, although the saturday surgeries are beginning to reduce that list. there are plans to eventually do more in a standalone private clinic affiliated with the ottawa hospital.
some critics of the orthopedic pilot project have raised concerns that it will poach staff from the hospital and that will further limit its ability to catch up on other surgeries. last month, this newspaper learned that a plan to catch up on backlogged cancer surgeries at the hospital was trimmed back from four to three days because of staffing concerns on a saturday when the orthopedic clinic was running.
advertisement
seely notes that many breast cancer patients have already waited longer than they should by the time they meet with a surgeon to discuss surgical dates. before the pandemic, waits for breast biopsies at the ottawa hospital were averaging three to four weeks. now they average seven to eight weeks, with some people waiting as long as 12 weeks for their diagnosis of breast cancer, she said.
“this is unprecedented,” she said.
kelpin said she understands why people would lobby to move up the queue or look for other options, even though she waited nearly six months for her own upcoming surgery at the ottawa hospital — they are scared.
“i am just upset that we have come to this point with the system. people are trying to figure out how to work around it, not because they are bad people, but because they are desperate,” she said.
“i don’t blame the doctors and nurses. this is killing them too.”
kelpin notes that ontario has an efficient screening system that comes with the message that early detection saves lives, but the health system can’t follow up quickly.
“(it) puts people in this position of giving them information to say you have cancer and it has to come out or it could get worse at some point … however, they don’t have enough time or staff to do it in a timely way.”
advertisement
for ottawa’s julie fine the decision to seek private treatment and surgery was straightforward. she was diagnosed with early-stage breast cancer in march 2020, just as hospital operating rooms were shutting down for all but urgent surgeries because of the pandemic.
vm-med in montreal remained open and fine was able to get in quickly. there was no way of knowing how long she would have had to wait in the public system as the pandemic progressed.
read more about the loophole in the canada health act:
fine was diagnosed with stage 1 cancer but was aware that if she waited too long, it could spread, turning into stage 2 or even much more advanced stage 3 cancer, which is more complex to treat and can have worse outcomes.
“i didn’t have an option,” she said. “everything was suspended indefinitely.”
she had a series of operations at vm-med, starting with a biopsy and including two lumpectomies and a subsequent mastectomy.
fine, a retired teacher who has three teenaged children with her husband, an entrepreneur, was happy with the speed at which she was treated at the private clinic and the care that they took.
advertisement
she posted a positive review of her experience, which ultimately helped others decide to also go to the clinic.
after the surgeries, fine was followed by an oncologist at queensway carleton hospital.
“they didn’t seem to mind that i had gone private,” fine said.
she paid tens of thousands of dollars for the surgeries and applied to the ontario government for reimbursement since she was unable to get timely treatment in the province. the government reimbursed her about $600 for the anesthesia.
“we are ok, we could afford it,” fine said. “but i do feel badly that most people can’t, or are not able to advocate for themselves.”
she has no regrets, calling the waits ottawa breast cancer patients are now facing inhumane.
“i didn’t feel guilty. i felt like i was taking myself out of the lineup,” she said.
“it was my decision. i am sure you could find someone who would say i could have waited and there could be a similar outcome. but maybe not and i didn’t want to wait to find out.”
lisa, meanwhile, didn’t hesitate to go for private surgery after speaking with fine and doing other research.
but she did struggle with feelings of guilt.
“i was really shy to tell people initially,” lisa said. “i felt like i was trying to get special treatment and jump the line and that i was more important than other people. i went through a million different emotions.”
advertisement
she has since come to terms with it and notes that she is unburdening the system she has paid into her entire life.
but her payment for the surgery came at a high cost. she used the money she received as part of a $900 million military sexual misconduct class-action settlement with the canadian military.
share story
