Rapid advances in cancer treatment have benefitted many people, but urgent change is needed in Canada's cancer care workforce to ensure patient care, according to an analysis published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.241425 .
"A sea change has occurred in cancer care," writes Dr. John Walker, an oncologist at the University of Alberta and Cross Cancer Institute, Edmonton, Alberta, with coauthors. "Although improved understanding of the genetic and molecular basis of disease has resulted in dramatic advances in treatment that are benefitting many patients, current resources and models of care in Canada do not meet the changing needs of people with cancer."
Targeted molecular therapy, immunotherapy, and changes in radiation oncology treatment have improved long-term survival rates for patients with early-stage lung cancer, melanoma, and other cancers, increasing the need for oncology care. For example, a recent study showed a 10-year survival rate in 52% of patients with melanoma treated with immunotherapy. However, these new therapies require patients to make many more visits to clinicians as they are complex to administer and may have adverse effects that need to be managed.
"This is a remarkable achievement, which further underscores why the cancer care system must adapt to meet the acute and longitudinal care needs of these patients," the authors write.
Solutions include
- Increasing the number of oncologists by increasing the number of medical school spots and the number of graduates who pursue oncology training
- A coordinated team-based approach to cancer care with general practice oncologists (GPOs), nurse practitioners, physician assistants, oncology nurses, and clinical pharmacists
- Increasing numbers of GPOs, nurse practitioners, and nurses with extra training in oncology
- Prioritizing optimal use of cancer care resources, which includes evaluation of the benefits and risks of therapies
"In situations where no data exist to indicate that outcomes are improved by surveillance, benefits should not be assumed; the cost and resource utilization of routine post-treatment assessments for asymptomatic patients — including patient travel, diagnostic imaging studies, and other interventions — is considerable," explain the authors.
"We have proposed general solutions to a complex problem; much work is required to operationalize these and other solutions to meet the evolving needs of patients with cancer in Canada."
In a related editorial https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250791 , Dr. Andreas Laupacis, consulting editor at CMAJ, argues Canada needs to address shortages of physicians in other medical specialties as well, with new models of care such as team-based, interdisciplinary clinics.
"Ministries of health, hospitals, primary care networks, and specialists must recognize that interdisciplinary specialty care clinics are an essential part of providing high-quality care to many patients, the need for such clinics will increase, and they should be funded appropriately," he writes. "Optimal models of funding will need to be established, but the expectation should be that all patients with certain diseases will have access to such clinics across the country."
