11:42am Wednesday 08 July 2020

Opinion: Cancer patients want control over where they get care

Where is the compassion for cancer patients? Is where to receive vital cancer treatment now going to be simply a matter of what postal code you live in?

The provincial government’s proposal to stop Montreal’s teaching hospitals from providing radiation therapy to cancer patients who live off-island, or to have doctors treat them without pay, might sound ridiculous if it weren’t so alarming.

But “repatriation” is the new buzz word in health care, threatening off-island access to Montreal Island teaching hospitals.

How would this be enforced?

In last week’s provincial budget, the government signalled a desire to adopt new patient-based funding. If the government is proposing payments based on head counts, will this be good for patients overall? Or will it turn out to be just another cost-saving measure at patients’ expense? Patients could come to be seen as a source of revenue, with hospitals striving to accommodate more and more patients. At the very least, significant investment in information technologies would be required to upgrade existing patient-file systems.

Beyond that, however, questions remain. Such as: How would money follow the patient if he or she required multiple treatments in different facilities, and how might the money be allocated?

The government claims that existing hospital budgets would not be cut in advance of patients choosing to go to local facilities. Would sanctions be imposed on hospitals that do not encourage off-island patients to go to their own community hospitals? Would there be repercussions for those who treat patients outside their territory?

If so, this is coercion, and a violation of medical ethics.

A patient’s cancer journey begins with a devastating diagnosis. His or her right to access health care teams and facilities in a one-stop shopping experience is paramount.

In a fight for their lives, patients want control over where they receive care.

This gives them peace of mind and affords them the best medical options available with the comfort and security that they will be followed throughout their ordeal by those familiar with their case.

Patients want their confidentiality respected, and to be involved in decisions affecting their treatment. It is essential that they receive seamless and timely continuity of care.

Forcing vulnerable patients to seek out treatment in community facilities that are less familiar with their case increases their stress and brings about medical errors, misplaced files and delays in treatment. Their health care would be placed in jeopardy.

It’s not about convenience and quicker service. The government doesn’t get it.

Preventing off-island patients from being treated in their hospitals of choice would also produce anxiety for friends and loved ones who are crucial supports. This would likely affect patients’ responses to life-saving treatments. Critical needs of cancer patients simply are not being considered.

This negative domino effect starts when a patient’s right to choose is breached. It’s that simple.

University teaching hospitals that provide advanced cancer treatments have benefitted from the generosity of private donors. Should these benefactors be denied cancer care in their hospital of choice? Should not off-island cancer patients who have been kept alive as a result of advanced treatments received in Montreal Island hospitals be grandfathered? Will community facilities really be able to provide necessary and up-to-date quality care? Will they receive adequate funding to ensure this? If so, over what time-frame?

The proposed move to patient-based funding should improve the quality and efficiency of services in theory, but there are too many disturbing and unanswered questions. It doesn’t inspire confidence. The lack of consultation so far with cancer patients, health care professionals, administrators and other stakeholders has been a clear violation of the law that calls for the participation of these parties in the development of policy.

Whatever happens, the government needs a reasonable plan that meets the urgent needs of cancer patients, and reflects what patients want.

Lisa Rosati-White is writing on behalf of oncology patients at the McGill University Health Centre and of members of the MUHC patients’ committee, including Douglas Burns, Arlene Field, Doreen Edward, Paul Horowitz, Evelyn Seligman, Shirley Ibrida, Mario Di Carlo, Maria Mastracchio, Lawrence Reich, Pierre Hurteau, Clarise Samuels and Brenda MacGibbon Taylor.

Lisa Rosati-White is secretary of the McGill University Health Centre’s patients’ committee.


Pierre Hurteau, co-president of the User’s committee of the MUHC
Mario Dicarlo, member
Richard Leboeuf-McGregor, member
Evelyn Seligman, member
Brenda MacGibbon-Taylor, member
Lisa Rosati-White, member
Douglas Burns, member

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