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Review underway of cancer services in western N.S., including question of whether radiation therapy could or should be located in Yarmouth

Dr. Drew Bethune (left), medical director of the Nova Scotia Cancer Care Program, and Dr. Jeff Kirby, health care ethicist and professor, Dalhouse Faculty of Medicine. TINA COMEAU
Dr. Drew Bethune (left), medical director of the Nova Scotia Cancer Care Program, and Dr. Jeff Kirby, health care ethicist and professor, Dalhouse Faculty of Medicine, say the review will be very thorough. TINA COMEAU - Tina Comeau

YARMOUTH, N.S. – In an age of tweets of 140 characters, social media status updates and one-line headlines, the man leading a review examining the possibility of offering radiation therapy services at the Yarmouth Regional Hospital says this is a complicated issue that requires a lot of deliberation.

And Dr. Drew Bethune, medical director of the Nova Scotia Cancer Care Program, says this is exactly what is happening.

The Nova Scotia Cancer Care Program – part of the Nova Scotia Health Authority (NSHA) – is conducting a review of cancer services in Yarmouth, Digby and Shelburne counties to determine the feasibility and sustainability of adding radiation therapy services at the Yarmouth Regional Hospital.

“Being diagnosed with cancer is stressful and patients and families in southwestern Nova Scotia have told us that travelling to Halifax for radiation therapy is an added strain,” Dr. Bethune says.

It’s an added stain from emotional, physical and financial standpoints.

This human toll is important and, Dr. Bethune feels, critical to the deliberation.

But it’s not the only factor that must be looked at.

So far work is underway to:

• Study recent cancer statistics to determine the potential number of patients in southwestern Nova Scotia who would benefit from radiation therapy at the Yarmouth Regional Hospital.

• Reach out to other provinces for information and expertise.

• Research cost estimates to design and build physical space (bunker), purchase and maintain equipment, should a decision be made to do so.

• Determine the size, makeup and budget for a clinical team needed to operate a radiation therapy service;

• Consider other cancer priorities and needs across the province and the trade-offs that would be necessary to add radiation therapy services in Yarmouth.

“On the one hand there’s the hardship of patients travelling and making decisions based on the travel to Halifax for radio therapy,” Dr. Bethune says. “On the other hand there’s our limited resources so anything we spend money on in one place there’s a trade-off that we can't spend it somewhere else.

“I have to apply the provincial cancer lens on this because I’m responsible for everybody, people from Yarmouth and the whole province,” he says. “So there is a balance and it requires very careful deliberation.”

There is a committee in place for this review. Its makeup includes seven cancer health professionals from the western zone, three patient public advisors, two of whom are from Yarmouth (one is a caregiver who travelled to Halifax with a loved one for radio therapy, the other is a cancer patient). There are also Cancer Care Program leaders and experts, along with other medical personnel who deliver cancer treatment.

Last week Dr. Bethune was in Yarmouth to meet with councils, the Yarmouth Hospital Foundation and representatives from the Western Nova Scotia Cancer Support Network (a Facebook group with around 19,250 members) to discuss the review process with them. An invitation to have someone representing these groups on the review committee is also being extended.

 

 

Dr. Drew Bethune (left), medical director of the Nova Scotia Cancer Care Program. TINA COMEAU
Dr. Drew Bethune (left), medical director of the Nova Scotia Cancer Care Program. TINA COMEAU

 

A VALID LOOK AGAIN

 

This isn’t the first time the issue of whether radiation therapy services could and/or should be located at the Yarmouth Regional Hospital is being looked at. But this will be the most serious examination, Dr. Bethune says. Asked what’s changed, he says, “There’s been enough interest here that I feel it justifies a very thorough review.”

He’s not only invested in the review. He’s very excited about engaging the public in this deliberation. No one person has all of the answers, says Dr. Bethune.

“I’m a real expert in a lot of areas of cancer, but that doesn't give me the corner on wisdom,” he says.

He also wants to put concerns to rest that this review will be Halifax-centric.

“I spent 35 years of my career as a chest surgeon and had lots of patients from Yarmouth and all over the province, so by nature I’m not really Halifax-centric,” he says. “My career has been provincial and beyond provincial. I think there’s always that concern, people only care about Halifax, but for me it's the reverse. I spent most of my time thinking about the province because we’re trying to get care close to home in any way that we can.

 

THE FACTORS TO CONSIDER

There is much to look at during this review beyond the human face of it, Dr. Bethune says.

One thing is geography and population. For the sake of this review the geographical area being looked at includes Yarmouth, Digby and Shelburne counties, as well as parts of Queens and Annapolis counties.

Population also goes beyond where a person lives.

“We’re looking at the number of patients we project based on cancer incidents, that would be candidates for radiation therapy,” explains Dr. Bethune. “We can predict the number of patients who will get cancer based on age and the demographics and then we can predict the number of those patients who would be candidates for radio therapy.”

Then, of course, there are costs.

“We have numbers from the previous assessment of $39 million to build it, $3.2 million to run it per year. We're going to review those numbers and we think they might be significantly lower,” says Dr. Bethune.

And throughout this you can’t dismiss the personal stories, says Dr. Bethune, saying the experiences of cancer patients and their caregivers are very important.

So to sum up the entire review, yes, it’s complicated. But it’s important, Dr. Bethune says.

 

The Yarmouth Regional Hospital. TINA COMEAU
The Yarmouth Regional Hospital. TINA COMEAU

 

CLOSER TO HOME

 

Currently there are no other parts of the province asking for radiation services.

“Sydney has two machines. Halifax has six, and the people in northern N.S. go to Moncton,” he says, “Yarmouth patients have to travel the farthest.”

Which is why this review will also look at what other things can be implemented to help patients receive other treatment closer to home.

“For instance, diagnosing lung cancer. We’re actively looking at reducing travel for people from this area for diagnosis of lung cancer,” says Dr. Bethune. “For head and neck cancerns, we’re looking for a one-day comprehensive clinic for people so they don’t have to make multiple trips to Halifax.”

Already there is more video technology in place to cut down on travel when it comes to consults for patients.

It’s because of this, Dr. Bethune says, that whatever the final outcome of the review, he believes there will still be benefits for patients in this region. He also agrees that having radiation services in Yarmouth would benefit the Halifax area in that it would open up more access to the machines there.

Still, there are a lot of pros and cons to be weighed.

REACTIONS TO REVIEW

Yarmouth resident Derek Lesser, who started the cancer network Facebook group, and his wife met with Dr. Bethune while he was in Yarmouth last week.

“I can say that regardless of the outcome, the process is going to be a very fair process that is ethical and comprehensive,” Lesser says. “When you meet people you can usually tell right away what they are about and it was very obvious that Dr. Bethune is a man of character.

“It would be hard to explain a feeling for people not there but the feeling I left with is that we are in good hands,” Lesser says. “We all need to remember that a thorough process takes time but it is worth the time to get it right.”

Yarmouth MLA Zach Churchill is another who feels the review process is in good hands.

“I don't know what the outcome of the review is going to be, but I do know that we have the right people looking at it and they are going to be answering key questions that we need to know,” he says. “Dr. Bethune has set up a really engaging process that is going to include the views of a lot of people and provide some objective answers to the key questions. Honestly, you could not ask for a better person to be leading this for us. He’s approaching it with an open mind and with a keen interest in doing what’s best for cancer patients.”

It is hoped the review will be completed by late spring, with a report going to the health minister at that time.

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