Quebec's cancer surgery wait list has jumped 41 per cent since early 2021

The number of cancer patients on surgical wait lists in Quebec has jumped by 41 per cent in the past year and a half, and more than one in five patients are now waiting beyond the medically acceptable delay of 57 days, the Montreal Gazette has learned.

Despite prioritizing cancer operations among other types of surgery during the pandemic, the Health Ministry is nonetheless confronted with a growing backlog. As of Sept. 10 — the latest date for which complete statistics are available — a total of 4,444 patients were on a wait list for cancer surgery across Quebec. On Feb. 2, 2021, that figure stood at 3,152.

The government is also falling far short of its stated goal of ensuring that “90 per cent of requests (for cancer surgery) must be completed within four weeks.” At present, 51 per cent of Quebec’s cancer patients are waiting longer than four weeks.

The most serious delays last at least two months. In mid-July of 2020, one in 10 surgical cancer patients in Quebec were waiting past the medical benchmark of 57 days. But that ratio is now more than one in five, and in some regions of the province it’s much worse. In Sherbrooke and Outaouais, for example, 40 per cent of such patients are waiting past that benchmark. In Gaspésie—Îles-de-la-Madeleine, it’s 62 per cent.

In contrast, in the vote-rich region of the Capitale-Nationale, it’s just one per cent.

Lengthy wait lists for cancer surgery were a problem long before the pandemic. But the decision to proceed with a policy known in French as délestage — purposely cutting back on clinical services to free up hospital beds for COVID-19 patients — has only inflated the backlog. Experts, including McGill University researchers in a recent study, predict that the consequence of délestage will be a higher cancer mortality rate in the years to come.

“We are surprised to see an increase in wait times and volume of patients … for oncology surgery since 2021, given that dozens of agreements with private clinics were put in place to address the backlogs caused by pandemic délestage,” said Eva Villalba, executive director of the Coalition priorité cancer au Québec.

“The great variability by regions also preoccupies us in terms of equity for all Quebecers, reflecting that a postal code still determines health outcomes. This further shows how important it is to have up-to-date, transparent data and objectives, but also more accountability of our health-care system to deliver high-quality, accessible care across all regions.”

Despite publishing regular updates on wait times on its website, the Health Ministry has not provided a breakdown of the types of cancer that have resulted in the longest delays.

Karine Iseult-Ippersiel, president and director general of the Quebec Breast Cancer Foundation, expressed concern that the cancer in some patients may advance to Stage 3 or 4 while they wait for their operation.

“I just think that the impact of the first and second waves in the pandemic we will only see in the years to come,” she said. “Any delays make the situation worse. When you can’t start care or a curing trajectory, well, you don’t get better as fast or you have more consequences to your cancer. And if you only treat the emergencies, going for the Stage 4 and Stage 3 cancers instead of the Stage 1 right away, well, your Stage 1 is going to become 2 and 3 and one day 4. So I think it’s in the medium and long term that we’re going to see the massive impact of the pandemic.”

At the last board meeting of the McGill University Health Centre on Sept. 21, executive director Pierre Gfeller sounded the alarm about delays in all types of surgery — not just cancer.

“We are particularly worried for wait lists in surgery, especially orthopedics, joint replacements,” Gfeller said. “We’re also worried about the cancer wait lists where we have many people waiting on our lists because we don’t have access to a bed if they require a hospitalization after their surgery.”

At the MUHC, at least 459 adult patients are waiting for cancer surgery. Of that number, 42 were waiting longer than 57 days as of last week.

Gilda Salomone, a spokesperson for the MUHC, attributed the delays to staff shortages at the Montreal General and Royal Victoria hospitals.

“The delay at the MGH is a result of a lack of beds due to nursing shortages,” Salomone explained. “The RVH has been running with fewer operating rooms due to staffing issues.”

The Health Ministry is aware that staffing shortages are making matters worse, but has not proposed any measures to address the crisis beyond a commitment to “review and share best practices implemented by establishments that succeed in operating their cancer cases on time.”

Robert Maranda, a Health Ministry official, suggested that some cancer patients in need of surgery may be able to wait longer than two months without any consequences to their health.

“It should be noted that for certain cancer types — the (medical) literature, combined with clinical experience, tends to demonstrate that for certain indolent tumours, no harm is caused to the survival of the patient, their treatment and their recovery, when the delay … is longer than the current targets of 28 and (57) days,” Maranda said by email last Friday.

“This is the case for the majority of thyroid and prostate cancers. Nevertheless, the prioritization of patients must be made according to the situation of each patient.”

Still, Villalba accused the Health Ministry of short-term thinking in dealing with cancer.

“If we had a long-term vision with a 10-year cancer plan like in Europe or Australia, we could be more proactive about strategies to ensure optimal access to surgery and other cancer treatments,” she said. “We are still building the plane as we go, and we need to make cancer a priority ASAP or we will soon be facing an avalanche of more advanced cancer cases.”

aderfel@postmedia.com

twitter.com/Aaron_Derfel

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