Monday, December 19, 2005

An Unwanted Journey: Day 0025 - Wait Times

Wait times are on the political agenda these days. The Ontario government has a Wait Time Strategy to reduce wait times for key medical services. Cancer surgery and diagnostic scans (MRI and CT) are two of the five services being targeted by the provincial government (the others are cardiac procedures, cataract surgery, and joint replacement). Unfortunately, it won’t be until December 2006 that the Wait Times Information System will be available in 50 Ontario hospitals.

In my case, I am not disappointed with the wait times for diagnostic scans at the Grand River Hospital (from the time of my first meeting with the surgical oncologist to the time of the CT scan was 10 days, 14 days to wait for the MRI). But, if the wait times listed on the Grand River Regional Cancer Centre’s site for chemotherapy and radiation therapy are reasonably accurate (they use the median time from a referral to the centre to the first treatment), then I will have to wait 5 weeks from December 14th (the day after the tumour board made its decision about the treatment protocol to be followed for my case) until treatment starts. That would be January 18th. Then, surgery would be exactly 12 weeks later on April 12th.

Comparison of wait times among the province’s regional cancer centres is done using data forwarded from each centre to Cancer Care Ontario. The GRRCC hasn’t yet posted its cancer surgery wait times on its own site, although there is a link on Cancer Care Ontario’s site where you can select Wait Times in Your Area which then takes you to the site where you can search for wait times by the category of cancer and location of hospital. That search engine told me that the median wait time for gastroenterological cancer surgery at Grand River Hospital was a median of 18 days, an average of 26 days, and 90% completed within 61 days. The times are calculated from the patient’s decision to proceed with surgery to the time when surgery is complete.

Rectal cancer that is treated preoperatively with chemotherapy and radiation therapy automatically pushes the surgery out by 12 weeks, so the comparisons for me for surgical wait times don’t compare readily with the standard wait times.

The problem is more subjective anyway, no matter what the statistics and figures indicate. I was told 5 days ago that there was confirmation on the pathology report of carcinoma and that the tumour board had agreed on the treatment protocol recommended by my surgeon. I called the GRRCC today to talk to the clinical director of supportive care. She was attuned to the problem of waiting for newly diagnosed cancer patients and quite sympathetic. Although she couldn’t tell me when I would be meeting with my medical team, she promised I would receive a call tomorrow to clarify next steps.

That’s all I can really expect, I guess. If I have to wait for chemotherapy and radiation therapy, then I’ll simply have to grin and bear it. But I can use the time to research, to work on my physical training program which I started today (I can barely walk!), and even try to enjoy the Christmas season. I may even put off my diet until Christmas is over.

The other major news today included getting copies of the pathology report and the text copies of the CT scan and MRI reports. Until I meet with my medical team at GRRCC, I should be careful interpreting the technical terminology of those reports, but from what I am reading, it appears there is no evidence of metastatis to distant organs, but possible lymph node involvement in two small nodes in the mesorectum (“two small presacral adenopathies”). The tumour itself is about 6 cm long and about 1.3 cm in thickness, which means the tumour has penetrated through the rectal wall. The MRI indicated “some spiculation and irregularity on the outer surface on the rectum”. The pathology report confirms the diagnosis: “invasive colonic adenocarcinoma arising within an adenomatous polyp.”

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