'Night and day': A B.C. breast cancer patient on her experience going to Bellingham for treatment

Some breast and prostate cancer patients have been travelling to Bellingham for radiation therapy since May as part of the province’s efforts to ease the backlog here

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A breast cancer patient who went to Bellingham for radiation therapy said the experience underscored just how overworked B.C.’s cancer nurses and doctors are.

Mia Toth, 59, of Abbotsford, said the difference between Peace Health St. Joseph Medical Centre in Bellingham, Wash., where she got radiation treatment, and Abbotsford Regional Hospital, where she received chemotherapy, was like “night and day.”

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“Everybody in B.C. has been wonderful. But they’re so overworked,” she said. “The chemo nurses were overworked. My oncologist is totally overworked.”

Two months after the province’s May announcement that eligible breast and prostate cancer patients would be sent to one of two cancer clinics in Bellingham for radiation therapy to ease the backlog here, Toth asked her oncologist to refer her to the program.

Toth is one of the first patients selected for the province’s Bellingham program to speak to the media about the experience. She would have preferred to be treated in B.C. but she became frustrated by the delays for radiation therapy.

“I wanted to stay in Canada, obviously. But I was like, ‘However I can get it done.’”

Toth was diagnosed with Stage 2 breast cancer in October 2022 and had a partial mastectomy at Abbotsford Regional Hospital in December. On a scale of 0 to 100 for risk of recurrence of the cancer, Toth was given a 43, which meant chemotherapy followed by radiation was highly recommended.

Toth started chemotherapy in January, which lasted until June. Based on Canadian benchmarks that state patients who require radiation therapy should begin that treatment within four weeks of finishing chemotherapy, Toth was supposed to begin radiation in July.

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Four weeks went by and Toth heard nothing about a timeline for the radiation therapy, which uses high doses of radiation to kill cancer cells and shrink tumours.

After six weeks, Toth reached out to B.C. Cancer for an update.

“They said, ‘It’s going to be another 12 weeks,’” Toth recalls. “Which rather upset me because I figured I should have been in line since January.”

Toth’s oncologist said if more than 12 weeks pass between chemotherapy and radiation, the radiation has a lower chance of being effective.

“I was sick to my stomach,” she said.

Mia Toth at her home in Abbotsford on December 11, 2023.
Mia Toth at her home in Abbotsford on December 11, 2023. Photo by Arlen Redekop /PNG

Toth decided to inquire about going to Bellingham.

She was accepted to the St. Joseph Medical Centre on Aug. 4. However, she still faced up to a six-week wait that would bring her past the 12-week point. When she asked her oncologist for an update on the timeline in the B.C. system, she was told she was taken off the waiting list here, despite being reassured by staff organizing the Bellingham treatment that wouldn’t be the case.

“I had not met the oncologist in Bellingham so felt extremely upset as I had no dates, and no idea if I would be confident with the treatment in the U.S.,” she said.

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Things started to progress by the end of August, when she had a CT scan and initial oncology appointment in Bellingham. She had confidence in the doctor and was told her radiation could begin on Sept. 4, just three days shy of the 12-week benchmark.

Toth and her husband, Jeff, would drive 45 minutes over the border every weekday for her radiation until Oct. 3.

She said the travel over the border was easy thanks to documents that confirmed the medical reason for the trip.

“Also, I was bald,” joked Toth. “I think having no hair probably made them realize I was doing radiation.”

She said the St. Joseph health-care staff was professional, efficient and gave her “as good an experience as you can possibly ask.”

Handout photo of Mia Toth, 59, at Peace Health St. Joseph Medical Centre in Bellingham, Wash.
Handout photo of Mia Toth, 59, undergoing chemotherapy at Abbotsford Regional Hospital and Cancer Centre. Photo by Jeff Elvins /Submitted

Toth said she’s happy with her decision to go to Bellingham, especially since it meant beginning treatment sooner.

She feels guilty knowing that by way of geography she was likely prioritized for the Bellingham program over patients who live in the Interior and northern B.C.

Data released last month by the B.C. United party revealed regional disparities among those selected to go to the U.S., with 213 patients in Fraser Health sent to Bellingham for treatment, compared with no patients from Interior Health and 14 in Northern Health.

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“It should be offered to everybody who has to travel (long distances) for treatment,” Toth said.

She was also upset to discover that many of the health-care staff working in Bellingham are from B.C., enticed by higher pay and better working conditions.

Health Minister Adrian Dix announced in February that oncologists in B.C. would get a raise from $410,000 a year to $472,000, which would make B.C. the highest-paying province for cancer-care doctors in the country. Dix said last week the province has hired 61 oncologists and 27 radiation therapists in B.C.

Toth said B.C. Cancer could address the backlogs by having radiation therapy offered around the clock, with premium wages for staff working night shifts.

“If we can send people to the States and pay for their hotels, pay for their food, pay for everything, they certainly should be able to pay staff more money and have (linear accelerators) going 24 hours or longer hours,” she said.

The province has budgeted $39 million a year for the Bellingham program, which is expected to treat an estimated 4,800 people over the next two years.

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It will cost the province three times as much to treat patients in the U.S.: $12,277 for a patient receiving five fractions of radiation therapy compared with $3,854 in B.C. Those figures don’t include travel and accommodation costs, which the province will pay for.

Dix has said the province is procuring more linear accelerators — the machines that produce radiation beams to kill cancer cells — for the new cancer-care centres planned for Nanaimo, Surrey, Burnaby and Kamloops as part of the province’s 10-year cancer plan.

The extent to which the Bellingham program is improving waiting times in B.C. was called into question last week amid B.C. Cancer data provided to Postmedia News that shows 75 per cent of cancer patients are receiving radiation therapy within the Canadian benchmark of four weeks, a drop from 77 per cent in May.

That’s well below the national average of 97 per cent and one of the worst rates in the country.

B.C. Cancer’s chief medical officer, Dr. Kim Nguyen Chi, acknowledged that the four-week Canadian benchmark “is what we want to achieve.”

However, oncologists also consider a different “clinical benchmark,” Chi said.

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“We know that if you wait too long for radiation, it’s no longer effective.”

The optimal time between chemo and radiation is between 12 and 16 weeks, he said.

“That’s in part why we advocated for the out-of-country system because we were concerned that there would be more and more patients that wouldn’t achieve that clinical benchmark where radiation no longer becomes effective. We didn’t want to see patients falling through the gaps.”

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B.C. Cancer’s chief medical officer, Dr. Kim Nguyen Chi outside LJ Blackmore Cancer Research Centre in Vancouver, BC, November 30, 2023. Photo by Arlen Redekop /PNG

Six months into the Bellingham program, patients who are being cleared from the waiting lists are those who were approaching that 12- to 16-week cutoff, he said.

Chi said there are 40 per cent fewer patients waiting to start radiation therapy, but because they’re already beyond the four-week benchmark, those patients aren’t reflected in the data. As those patients are seen faster and taken out of the B.C. waiting list stream, the hope is that more people will receive radiation within the four-week Canadian benchmark.

“We actually expected our (Canadian benchmark) numbers … to look worse before they look better,” he said.

Those with breast and prostate cancer were selected for the Bellingham program because they make up the largest patient population receiving radiation and face the longest waiting times.

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Chi expects to see the length of time people are waiting for radiation decrease significantly over the coming months as more people are selected for the Bellingham program.

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