One issue that comes up in the discussion of nationalized health care is wait times. We’ve all heard horror stories about patients having to wait for seemingly insanely long periods of time before receiving the sort of basic medical care we take for granted in the United States. It’s hard to take anecdotal evidence seriously, though. There are certainly plenty of tales of woe involving the US health care system.
Recently I came across a story about wait times for knee surgery in Quebec. I was unaware that there is an organization, the Canadian Institute for Health Information, tracking wait times for various procedures and documenting progress in reducing those wait times. I looked up the collected data and saw that among the statistics tracked are wait times for radiation therapy.
At the CIHI website, there are tables giving wait times and trends for 2007-2009. These wait times are broken out by province. Looking at the 2009 report gives values for the period of April to September 2008. Each province reports their results differently, but most report the percentile of patients that meet their benchmark of 28 days between the date the oncologist made a decision that the patient was ready to begin therapy and the date of the first radiation therapy treatment. Some provinces like PEI and Manitoba report that nearly 100% of their patients start treatment within that time period. On the other end, Newfoundland and Saskatchewan report that 85% percent or fewer of their patients meet that benchmark. Unfortunately, while the report indicates that wait times for other types of medical are decreasing, radiation therapy wait times are either steady or climbing.
There will always be some delay between the oncologist decision and the first treatment. The treatment needs to be planned by a dosimetrist and approved by both a physicist and the physician. For complex treatments, this can take longer than 7 days, but the vast majority of treatment plans can be completed in this time given adequate staffing levels. The clinics I am familiar with in the USA treat most patients within 7 days and virtually everyone in 14 days or less.
The report does not explain why wait times are so long in Canada, but surely some part of it is a lack of resources. A report from the Wait Time Alliance, an umbrella group of Canadian physician organizations, blames a shortage of equipment and staff. The report states that staff are “working late into the evenings”, but that can only go so far. A linear accelerator needs some down time for maintenance and safety checks from the physicist. Beyond a certain number of patients, the only solution is to buy another linac. However, linacs are expensive both in their upfront cost and in maintenance.
While it is clear that wait times in Canada are longer than those in the US, it is unclear that patient outcomes are worsened because of it. The two types of cancer that make up the bulk of radiation therapy patients are breast and prostate. Some forms of both prostate and breast cancers are non aggressive and those patients will probably see no difference in outcomes if treated a few weeks later.
An interesting study would be to look at outcomes in the US and other countries for various tumor types. The hard part in such a study is controlling for demographic differences (these differences are what lead to the US having such a comparatively high rate of infant mortality). However, this is the type of info we need in order to make an informed decision about the future of our health care system. Otherwise, we’re left with dueling anecdotes.
