A few weeks ago the Trail Times was contacted by a family member of a cancer patient currently undergoing treatment at Kootenay Boundary Regional Hospital, under the care of Dr. Len Scotland.
After decades of dedicated service to countless patients and their families, Dr. Scotland is soon to retire.
To date, there is not a dedicated oncologist that will collectively take over care of cancer patients in the Trail area.
Understandably, this family member is extremely concerned about the continuity of care for her loved one.
“Do we now have to travel for appointments?” she queried, “This is an inconvenience for our situation, but horrible for someone who is very sick with cancer.”
Further, she questioned the efficacy of oncology care and ongoing follow up care without one person at the helm.
“Who really is in charge of making sure all cancer care appointments are being monitored and ordered as needed?” she said. “This really seems like a slap in the face to rural residents.”
The Times sent questions to Interior Health to find out answers for this family member and all patients and their families who will be in the same boat this month, after Dr. Scotland retires.
Interior Health (IH) has provided the Trail Times (TT) with critical details for affected patients and families, which is why the newspaper is publishing replies in their entirety.
TT: Is there a physician coming to this area to replace Dr. Scotland?
IH: In anticipation of Dr. Scotland’s retirement, and because of the retirement last year of Dr. Malpass in Nelson, BC Cancer has been advertising three full time Medical Oncologist (MO) positions for the Kootenay Boundary region and practices.
Unfortunately, there have not yet been applicants, as there is a limited supply of these highly-trained specialists, and many other locations in and outside B.C. are similarly trying to recruit.
Because of the current inability to recruit a specialist on site, BC Cancer oncologists based in Kelowna at the Regional Cancer Centre will take responsibility for providing consultation to patients in the Kootenay Boundary region.
Consults will be provided virtually or in-person, depending on circumstances and patient preference.
A group of family physicians in the Nelson and Trail area, who have taken significant extra training in oncology practice, have stepped forward to provide on-site supervision of treatment recommended by the BC Cancer oncologists.
These physicians are generally titled as “GPOs” for General Practitioner in Oncology. GPOs assist with delivery of cancer care in many clinics provincially and nationally.
TT: How many patients does this leave in the lurch with Dr. Scotland retiring?
IH: All cancer patients requiring active treatment will be reassigned to a Kelowna-based BC Cancer Medical Oncologist, so that specialist advice will be available as needed, to all.
Patients already on an established treatment plan organized by Dr. Scotland will complete that under the supervision of the GPO group.
Any questions or concerns that arise in regard to these patients and their care will be evaluated first by the GPO on site, and advice sought when necessary from the assigned regional MO.
There are approximately 130 patients currently on active treatment plans that will be assigned to a Medical Oncologist at BC Cancer for advice when needed. Some may need new advice very soon; others not for years, potentially, as some cancers are stable for lengthy periods.
Following Dr Scotland’s retirement, all new consult requests will be sent to BC Cancer—Kelowna for assignment to a specialist with particular expertise in that cancer type, and that specialist will inform the patient and local GPO team of the treatment plan.
That treatment will then be delivered locally.
TT: Is there any particular factor keeping Dr. Scotland from being replaced in this region?
IH: There are many available Medical Oncologist positions in B.C. and across Canada, with a relatively small number of new Medical Oncologists completing specialist training each year.
It is currently a challenge to recruit necessary additional staff even at the regional cancer centres. BC Cancer will continue active efforts to recruit specialists to these positions, but this will take time.
In the meantime, we have developed a plan to share the care for cancer patients between regional specialists and local GPOs and their teams.
The Kootenay Boundary is not unique in utilizing this model of shared care.
This model has been in existence for many years, serving a variety of communities in Interior Health and in other regions of B.C. For example, Cranbrook, Penticton, Grand Forks, Williams Lake, and 100 Mile House all use this collaborative model of care.
TT: What is the most important factor local cancer patients should know at this point?
IH: We recognize change is stressful, and raises concerns and questions.
What is most important to know is that Interior Health and BC Cancer medical leaders and staff are working very hard to plan for as seamless a transition in care as is possible.
Patients will not be without care, but will have a different method for accessing care, receiving this care from a larger group, rather than a single practitioner.
Just as has been done previously, BC Cancer will work to ensure that patients have access to the same level of expertise and treatment throughout the province, even if it will be delivered differently.
Some patients with more rare or complex situations will already have received additional input to their care by a specialist at the Regional Cancer Centre, and will continue to receive input from that familiar specialist, as needed.
Many patients will have visited the Regional Cancer Centre for radiation treatment, which is only available at major centres.
When possible, efforts will be made to coordinate appointments to reduce travel for patients who require the attention of both types of specialist: radiation and medical oncologist.
TT: Will cancer patients now have to try to find a doctor in Kelowna?
Patients referred to the Regional Cancer Centre will have their information reviewed by the soonest available consultant that specializes in their type of cancer, and an appointment will be scheduled.
The physician team in Kelowna will coordinate drug treatment in the patient’s local centre in the Kootenay Boundary region — in Trail, Nelson, or Grand Forks — in collaboration with the local oncology team.
IH replies to family member who contacted the Times:
Question: Do we now have to travel for appointments?
Answer: Treatment services remain available in the Kootenay Boundary.
A patient may need to travel for their initial consultation appointment with an oncologist at BC Cancer – Kelowna, but this will be determined on a case-by-case basis influenced by circumstances and patient preference.
Virtual services are available if they are deemed appropriate by the provider and the patient.
Question: Who really is in charge of making sure all cancer care appointments, scans etc. are being monitored and ordered as needed?
Answer: The oncology specialist at BC Cancer – Kelowna who reviews the initial consult request will determine the needed tests and appointments and organize these with their team members (clerk, secretary, nurse).
If the patient is to receive a treatment plan at their local oncology centre, the details of the plan will be clearly laid out to the local group, and the local GPO and team will organize appointments and tests necessary to safely proceed through treatment.
The initial consultant will also advise on appropriate plans post-therapy, and there may be ongoing updates and advice exchanged between physicians, and updated appointments with the appropriate team member, depending on the situation.
The local family physician will be informed all along the way.
If any other type of specialist help is needed (for example, a surgeon), whenever possible, a local community specialist’s help will be sought.
Question: This really seems like a slap in the face to rural residents?
Answer: Dr. Scotland has served his community and region well for a long time.
IH looks ahead
Over the last two decades, cancer research has led to a large increase in complexity in the practice of oncology, and fortunately, many more types of helpful or curative treatments, for more people.
Most new graduates of Medical Oncology wish to narrow their focus more than would be possible in a smaller community.
However, as the population of the Interior regions grows, and considering the incredible beauty and opportunity of the region, we remain hopeful that we will be able to attract a small group of Medical Oncologists to work together in this location, where they would be supported by many connections with the BC Cancer network of physicians and services, and by Interior Health.
Interior Health and BC Cancer have been working hard to ensure expert and compassionate care continues to be provided for everyone in need.
Interior Health would like to thank Dr. Scotland for his years of service in Interior Health and wish him very well in his upcoming retirement.
BC Cancer FoundationBC HealthKootenay Boundary Regional HospitalOkanagan