Cancer has touched the life of every individual in Newfoundland and Labrador, if not directly, then through the cancer diagnosis of a friend or family member. There are certain types of cancer that are particularly prevalent in the province. For example, Newfoundland and Labrador has the highest rate of colorectal cancer in men and amongst the highest rate in women. However, more encouraging is the fact that through continually enhancing services such as the provision of screening programs and evidence-based treatments, the proportion of those surviving a cancer diagnosis has increased considerably over time.
I’ve spent 14 years as an oncology nurse – both in the United States and in Canada. Since returning home to Newfoundland and Labrador four years ago, I first worked as an oncology nurse at the Dr. H. Bliss Murphy Cancer Centre, and for the past two years have served as Quality and Planning Coordinator with the Cancer Care Program.
From the beginning, I have loved working in oncology. This area of nursing is challenging, but also hugely rewarding.
I have always valued the special relationships I have been able to form with patients and their families.
I have also learned first-hand the incredible stress and impact of a cancer diagnosis on a family member, when my mom was diagnosed with breast cancer in 2007. Thankfully, through early detection and effective treatment within our health care system, today she is a cancer survivor.
Through my family’s experience and through my many years of working with cancer patients I have learned some valuable lessons; take nothing for granted, seize every moment and opportunity and live life to the fullest!
The Cancer Care Program of Newfoundland and Labrador is dedicated to the delivery of cancer care services throughout the province. And the tide is turning – cancer is no longer considered to be a terminal illness, as it was once considered to be.
History of Cancer Care in
Newfoundland and Labrador
Cancer care in Newfoundland and Labrador has seen many changes over the past seven decades. The number of recorded diagnoses has increased and so have the services available to those who receive a diagnosis. In its 2013 report, Accreditation Canada had praise for the work of Eastern Health’s Cancer Care Program, stating: “The Cancer Program should be extremely proud…they are definitely committed to excellence in cancer care for the citizens of Newfoundland and Labrador.”
Our health care system has always been challenged by our widely dispersed population over a large geographic area. In spite of these challenges, cancer care has seen tremendous growth.
The first radiology department was established in 1945 at the old General Hospital in St. John’s. This was followed by the initiation of chemotherapy treatments in the mid-70s, the establishment of a Cancer Clinic in 1981, and the opening of the Dr. H. Bliss Murphy Centre in 1994. Other developments have included the opening of the Cancer Centre in Western Newfoundland in 2000 and the commencement of screening programs for breast, cervical and colon cancers in the 1990s and 2000s. In short, the fight against cancer has been progressive.
Over the past 68 years, the cancer care team has also grown exponentially, from one physician and one nurse in 1945 to the current composition which numbers approximately 200 staff. Physicians, nurses, radiation therapists, physicists, managers, clerical support staff, patient navigators, clinical trials researchers, pharmacists, PCAs, social workers and dietitians all work side-by-side to provide comprehensive, compassionate care to our patients throughout Newfoundland and Labrador.
More Cases. More Care.
In 1945, the number of new cancer cases recorded in Newfoundland was 91; in 1985 that number grew to 620; and in 2014, it is estimated that there will be 3,300 new cancer diagnoses. The primary reason for this striking increase over time is the vast improvement in the registration and documentation of cancer cases. Case ascertainment has improved so dramatically that we now have a much clearer picture of the true number of diagnoses in our province each year.
Other factors that contribute to the increase in the number of cases of cancer include:
- an aging population;
- increased life expectancy;
- high rates of risk factors and genetic factors; and
- improved technology for screening and diagnosis.
Despite this jump in incidence, tremendous advances in cancer treatments have also meant a dramatic change in focus. When it comes to a cancer diagnosis, today the approach for many types of cancer has changed, from “dying from cancer” to “living with cancer.” This significant change can be traced with a brief look at the key forms of cancer treatment offered in the province:
Surgery: Current surgeries to treat cancer come in many forms, including, diagnostic, curative, reconstructive and palliative. Surgery can also be done to determine the stage of a cancer or to remove an organ or tissue as a preventative measure (prophylaxis). Present day surgeries for certain cancers are often less extensive than they were in the past, yet equally and often times more effective.
Chemotherapy: Chemotherapy is the use of drugs to treat cancer. Most of these medicines are considered cytotoxic and can cause a range of side effects to the body while working to kill cancer cells. The earliest chemotherapy drugs were first tested in the 1940s, and the numbers of drugs were small. Through many years of development and clinical trials, there are now countless chemotherapy drugs used, some alone and some in combination with other drugs. This progress has improved survival for countless numbers of patients. One tremendous advance since the 1980s and 90s is the introduction of targeted therapy. Targeted therapy drugs, like any drug used to treat cancer, are technically considered “chemotherapy,” but do not work in the same way as standard chemotherapy drugs. They are often able to specifically attack cancer cells while doing less damage to normal cells, thus tending to have less severe side effects than standard chemotherapy drugs. The use of targeted drugs in treating cancer has grown considerably in recent years.
Radiation Therapy: Radiation therapy uses high energy particles or waves to destroy or damage cancer cells. The specialized equipment used today at the Dr. H. Bliss Murphy Cancer Centre provides highly effective and safe treatment in a much shorter time than it took in the past. In the 1980s, radiation therapy consisted of one cobalt and one linear accelerator. Today, that’s grown to four linear accelerators. In the 1940s, one radiation therapy treatment session would have lasted for approximately 30-40 minutes; today, a single treatment lasts approximately 10 minutes. Radiation therapy imaging has also improved dramatically and the many side effects that patients suffer are lessening.
Molecular Imaging: Eastern Health is also in the process of implementing a new Molecular Imaging Program, which will introduce the first positron emission tomography/computerized tomography (PET/CT) scanner to the province. PET/CT imaging is most commonly used in cancer care. A large number of cancers can be further evaluated regarding how extensive they are, where they have spread and how they respond to treatment.
Unlike the cancer care of the early days, today’s Cancer Care Program is an interdisciplinary program. When a patient visits the Cancer Centre for the first time, he or she – and their family – will often meet with both a medical and radiation oncologist, the oncology nursing staff, a pharmacist, and if required, the dietician and social worker. All disciplines work as a team to provide the best and most comprehensive care to patients.
Access to Treatment
Cancer care services today are delivered across the province. While radiation therapy is delivered only at the Dr. H. Bliss Murphy Cancer Centre in St. John’s, there are tertiary cancer centres located in Gander, Grand Falls-Windsor and Corner Brook that provide chemotherapy administration and supportive care services. In total, chemotherapy is administered at 20 health care facilities across Newfoundland and Labrador.
In 2006, access to cancer care got a tremendous boost with the launch of the Tele-oncology Program. Tele-oncology uses phone lines and video-conferencing to deliver face-to-face interaction between the patient and physician and provides patients living in rural areas with access to quality cancer care from their oncologist – without having to leave their home community. Newfoundland and Labrador is leading the country in the successful use of this program.
Patient Navigation began in 2011 and is a process by which a person with a suspicious finding or known cancer is guided through the cancer care system by highly-trained nurses. The intent of this program is to provide practical and emotional support to patients and their families – and to help them access a variety of medical and community services in a timely and efficient manner.
The use of patient navigation services also enables patients and their families to play a more active role in their care, creating a better experience and easing transitions through the various stages of the cancer journey. There are seven patient navigators located in various regions of the province including, St. John’s, St. Anthony, Corner Brook, Gander, Clarenville and Happy Valley-Goose Bay. Feedback shows that they are a major benefit and resource to patients.
Prevention and Early Detection
Ultimately, for many cancers the chance of recovery depends on the stage or the amount or spread of cancer in the body when it is diagnosed. With that in mind, a number of screening programs have been established during the past two decades to enable early detection.
The Newfoundland and Labrador Breast Cancer Screening Program began in 1996 and offers breast screening services to women aged 50-69 years. There are three breast screening centres in the province: one in St. John’s, one in Gander and one in Corner Brook. These centres provide mammography, physical examination of the breast by a nurse, and education about breast health awareness to this population of women.
In 2003, the Cervical Screening Program began, supporting an organized provincial approach to cervical screening. Cervical screening is usually performed using the Pap test, and is a way of preventing cervical cancer from developing. Pap screening may also diagnose the disease at an early, more treatable stage.
The Newfoundland and Labrador Colon Cancer Screening Program was launched in July 2012 in the Western Health region and expanded into Central Health in June 2013. The program seeks to screen individuals 50-74 years of age who are at average risk for colorectal cancer. Since launching the program, more than 3,100 individuals have requested a home screening kit and approximately 70 per cent of these have been returned for analysis at the lab. Those who test positive go on to have more intensive investigation via a colonoscopy. Some early stage colorectal cancers have been detected where only surgical intervention was required, resulting in a favorable prognosis and less negative impact on patient quality of life. Cancers that are diagnosed at earlier stages are often easier to treat and cure. For example, if detected early, about 90 per cent of colon cancers can be treated successfully.
Success by the Numbers
Today, smoking is the biggest single preventable cause of cancer in the world, and there is no denying that attitudes have changed since the 1950s. According to a report by the Canadian Partnership Against Cancer entitled Population Health in Canada’s Largest Cities: A Cancer System Performance Spotlight Report (September 2013), 19.9 per cent of the population in St. John’s reports smoking daily or occasionally. However, according to the same report, based on statistics from 2010-11, St. John’s also reported the highest percentage of smokers who quit smoking in the past two years. As we work to decrease smoking rates, we are working to save lives.
As oncologist Dr. Joy McCarthy says, “Cancer is not just one disease. Each one has unique causes, characteristics, behaviours, genetics, and responses to treatment.” According to Joy, when this was recognized, much effort has been put into “translational research” in hopes of finding the “targets” which allow cancer cells to grow. Blocking these targets in some way then could, theoretically, lead to the death of these cells, and thus, elimination of cancerous tumours.
Meeting the Challenge
It was only a few short decades ago that the prognosis for people with cancer was not nearly as favorable as it is today. Today, more and more people are surviving cancer and attention is focused on quality of life and long-term outcomes.
Due to advances in treatment options, cancer can be cured and is no longer a word that people are afraid to speak, according to Elaine Warren, Director of Cancer Care.
“Ensuring that we help to mitigate the risks and provide the appropriate, high quality care for our cancer patients is both a priority at Eastern Health – and a challenge – given the aggressive nature of the disease,” says Elaine adding, “but it’s a challenge that we are prepared to meet. We know that cancer can be beaten, and by working together we can transform that knowledge into reality.” ■
This story was written by Suzanne Condon, member of the Management and Leadership Team of the Cancer Care Program, based in St. John’s, and Deborah Collins, a Communications Manager with Eastern Health.