October 20, 2014

Royal Victoria Hospital in Montreal
Health & Ed | March 13, 2014
Decentralizing cancer care
Spatial discrimination due to budget allocations in Montreal hospitals
Written by | Visual by Tamim Sujat | The McGill Daily

Starting April 1, cancer patients from the broader Montreal region will be restricted from seeking cancer care outside of their own district by the Quebec government. McGill University Health Centre and the Jewish General Hospital (JGH), the leading hospitals in Montreal and surrounding areas in research, teaching, and providing comprehensive cancer care, will have to refer new patients to a hospital in their area. This especially applies to people who live off the island of Montreal. According to the Montreal Gazette, Health Minister Réjean Hébert decided to implement these budget allocations to reflect the decreasing number of cancer patients at the Jewish General Hospital, the McGill University Health Centre, and other Montreal hospitals, a claim which many doctors do not support. Limiting people to getting care closer to their addresses may make sense on paper, but might have serious impacts on the quality of care that cancer patients will receive.

Le Portail Santé Montréal declined an interview, yet in a press release sent to The Daily, they state that this restriction will only affect new patients who have not yet started treatment. Patients who have already been admitted can stay with the doctor they have been seeing. Even though it is not certain whether new patients will be able to chose their hospital under some circumstances, Nathalie Rodrigue, President of the Coalition Priorité Cancer au Québec, an organization that rallies different groups in order to fight for more effective cancer treatment, is not so confident about it. “Nothing has been put in writing to guarantee this,” she said, “so the patients are still vulnerable. The Coalition is waiting to see what happens come April 1 and beyond.”

Getting specialized care close to their homes would definitely be more convenient for cancer patients, as it would keep them from having to take long daily trips to far-off hospitals; however, the specialized treatment cancer patients require is not available to the same extent at every hospital. “There are a myriad of treatments in cancer care that make it different from other kinds of care,” Jen Greig, a cancer patient, told The Daily in an interview. Greig was diagnosed with advanced lymphoma in 2008. She received treatment at Saint Mary’s Hospital, a smaller hospital in Montreal, and experienced the benefits of being treated in a familiar environment. “When you’re super stressed out, getting all sorts of weird procedures done to you, familiarity really helps reduce the experienced level of stress,” she said. Yet, being part of the old system, Greig was able to seek alternative advice from other hospitals, including the JGH in Montreal. She stated that Saint Mary’s Hospital couldn’t do a lot of things like stem cell harvesting and magnetic resonance imaging, which forced her to go to the JGH. Next to the transportation costs and time, Greig also expressed concern about “the psychological aspect of having to make so many trips to the hospital.”

Portail Santé Montréal specified that the $6 million in funding will be transfered to support hospitals in the Laval and Montéregie regions in their new radiation oncology cancer centres. In an interview with The Daily, Eduardo Franco, head of McGill’s oncology department, stated, “Decentralization of our services is a good idea, and I believe the government has the very best intentions. I’m quite wary, however, [about] how this plan may be rushed to implementation because of financial concerns. Inevitably, if change is rushed, the quality of services will be affected and the patient will be the one who suffers.”

“There will be a ripple effect of this dispersion of funding [that] may affect the quality of oncology doctors who graduate, the quality of teaching, the quality of treatment, the quality of specialty, the quality of care,” Franco continued. This decentralization of care might not be able to guarantee the same level of efficiency. He continues to explain that cancer treatment is one of the most expensive treatments one can receive, since it requires specialized teams for diagnosis, treatment, and follow up. Teams need to be all in one place, gain trust in each other’s competencies, and communicate with and rely on each other. Without this synergy, miscommunication is likely. After the allocation of funds, patients newly diagnosed with cancer, with limited time to get diagnosis and treatment, may end up unnecessarily running around to get the services they need.

Coalition Priorité Cancer au Québec opposes the decision to reallocate funds. “This decision is being made solely based on financial savings, when it should be ethically based on the quality of patient care,” Rodrigue told The Daily. “The patient will pay for this single-minded political decision.”
A transfer of funding from the major English-speaking hospitals to French-speaking ones might create difficulties in getting service for anglophones who live off the island of Montreal. A report by the Community Health and Social Services Network from last year states that English speakers comprise 13.4 per cent of Quebec’s total population, with 66.8 per cent of them residing in the Montreal-Laval region. A 2011 report by the Institut national de santé publique du Québec states that only 14.6 per cent of the 10,540 doctors, and 12.67 per cent of the nurses in Quebec, only use English at work. This makes it increasingly difficult for anglophones to access healthcare in English.

The new implications also parallel those of the Quebec charter. A group of McGill professors, psychiatrists, and researchers specializing in mental health published a letter against the Quebec Charter, stating that the JGH was built in the 1930s “because of systematic discrimination at major academic and healthcare institutions in Montreal.” Whether or not the current budget allocations may be an anti-anglo issue, decentralizing cancer care will probably result in not having the same level of expertise quality of care for cancer patients of different backgrounds.

Allocating $6 million in funds to the Laval and Montégerie hospitals from the JGH, Montreal General Hospital and other hospitals on the island most likely will have detrimental impacts for cancer care in the long run if the funds are not implemented carefully. Cancer care is specialized and highly complex. It needs a team of people who can easily communicate in their specialty to ensure the patient does not get lost in translation. Dispersion of resources and specialized care could have negative implications for patients and research. Cancer care requires the best training, best resources, and the best service, to provide the best care.

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