Sending B.C. cancer patients to U.S. for care will triple the cost

Dec 11, 2023

The B.C. government announced Monday that beginning May 29, it would send about 50 breast and prostate cancer patients per week to the U.S. for care.Amy Romer/The Globe and Mail

Sending B.C. cancer patients to undergo radiation therapy in the United States will cost the province three times the amount for the treatment at home, excluding travel costs, according to the province.

The B.C. government announced Monday that, beginning May 29, it would send about 50 breast and prostate cancer patients per week – or about 2,400 patients per year – to two clinics in Bellingham, Wash., in response to unacceptable waiting times at home.

The Ministry of Health says most of these patients will receive five fractions of radiation therapy, which would cost $3,854 at home, compared with $12,277 at the private cancer centres in Bellingham. This does not include other expenses such as travel, accommodations and meals for the patient and a caregiver, which easily amounts to thousands more. The ministry says it is earmarking up to $39-million per year for the initiative, which includes $5-million annually in contingencies.

But health policy experts say it's still the best option to provide some quick relief to a system under pressure.

Jason Sutherland, a professor in the Centre for Health Services and Policy Research in the School of Population and Public Health at the University of British Columbia, whose research focuses on health system funding policy and patients’ health outcomes, said the hefty price of sending patients across the border can be expected.

"The province needs an outlet valve, and probably much like they’re doing with the private surgical centres to induce them to take increases in volume, they’re probably paying them a price much higher than their cost," Dr. Sutherland said. (A report released last summer through the Canadian Centre for Policy Alternatives found that the province had spent $393.9-million since 2015-16 outsourcing surgical procedures and medical imaging to private clinics.)

"I would imagine that Bellingham, being almost as close as possible for a cancer treatment centre to the Vancouver region, had pretty strong negotiating power here."

Sending patients out-of-country for care is not new. Between 2018 and 2020, B.C. sent cancer patients to Bellingham for medical imaging as cancer centres in Victoria and Kelowna awaited new PET CT scanners. Ontario has also sent patients to Buffalo, Detroit and Cleveland for radiation therapy, stem cell transplants and other life-saving treatments. Quebec has sent cancer patients to Vermont.

What is unexpected is the volume of patients now being sent south, Dr. Sutherland said. The Globe and Mail has reported extensively on growing waiting times at the province's cancer agency, with dozens of insiders, including four past presidents, blaming growing bureaucracy and poor planning over many years for the capacity challenges it faces today.

In 2021, 88 per cent of patients in B.C. were able to start radiation within four weeks – the national benchmark for the maximum amount of time deemed appropriate to wait – which made B.C. the poorest performing province in a country where the national average was 97 per cent. New internal data obtained this week by The Globe show that that has fallen to 77 per cent this month.

Dr. Sutherland said there are a number of upsides to the temporary fix.

"It is an indicator, somewhat, of poor performance of the health system not being able to look after its insured population of residents," he said. "And, hopefully, in the medium and longer term they address meeting demand with supply, with cancer treatment centres and an appropriate number of oncologists and all the supporting services. But they can't do that very quickly, so this is probably the best they can do. And it's not bad, because it's convenient."

Damien Contandriopoulos, a professor in the School of Nursing at the University of Victoria whose research includes health policy-making processes, said while the cross-border travel and associated costs make sense given the urgency of cancer treatment, he's troubled by the lack of transparency from government on why it is needed.

"What concerns me is the way that it was framed, as if it were good news, as if it were a solution. I think the province should explain what's going on. It's concerning not to hear them say anything about the causal factors," he said.

Dr. Contandriopoulos said health researchers have been "shouting" that Canada's transforming demographics would bring about massive demands for services such as home care, long-term care and cancer treatment, and that provinces, overall, have been timid in their response.

"The only way as a citizen I would be assured that this is just an emergency situation and that they’re working on solutions is if they were acknowledging this," he said.