Oncology nightmares: Edmonton cancer victim dies without seeing oncologist, another had to fight system to get treated

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The late Don Agnew was living proof a patient could spiral down from symptom to biopsy to CT scan to diagnosis to palliative care to death — all without seeing an oncologist.

The Edmonton contractor was diagnosed with Stage 4 pancreatic cancer in February 2023. A CT scan showed metastasis to other organs.

He got those results. His family held their breath.

Then, radio silence.

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“He wasn’t told anything … he never received a call from the Cross Cancer Institute, or any doctor for that matter, in terms of what the results were,” his son Mark recalled.

“That initial consult, shortly after the results of a biopsy are received, it took almost 60 days before we got a call back from the Cross Cancer Institute to schedule an appointment,” he said.

“At that point, he was in hospice, so it didn’t matter.”

Don and Mark Agnew
A self-made man who built a successful construction company, Rescom, Don Agnew, 69, was diagnosed with pancreatic cancer in February 2023 but died before he could see an oncologist. Alberta has the lowest number of oncologists per capita across Canada. Agnew is seen pictured with his son, Mark (right). Supplied Photo/Mark Agnew

Mark Agnew tracked down a friend, Dr. Brock Debenham, a radiation oncologist at the Cross, to interpret results and prognosis.

The elder Agnew had three to five months to live.

“He provided us with some choices, whether or not getting treated by an oncologist, radiation or chemotherapy, surgery.

“But in the end, it didn’t matter. We didn’t receive a call from the Cross Cancer Institute until 10 days before (Don) passed away on May 6, 2023,” the younger Agnew said.

Prepared by Debenham, Don got affairs in order: a few good weeks for family, palliation, hospice care.

No one has shed light on communication protocols Alberta Health has in place for such diagnoses, Mark said.

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“I don’t know the inner workings of our health-care system, so I can’t put a finger on it, but Alberta Health’s in charge of our medical system. I don’t know if it’s an individual or system failure.”

A different triage

Triage for cancer patients differs from that in ER, where the sickest get the most urgent attention.

Cancer patients thought to have the greatest benefit from treatments are put at the front of the list, whereas patients who may not benefit as much from treatment may never be seen, Debenham said.

But for someone with a dire diagnosis, it’s about communication, Mark said.

“Even those in dire straits, such as my father, who (probably) would not have benefited from any treatment, at least, deserve a courtesy of a phone call from a medical practitioner to say, ‘These are the results of what we found inside of you, And this is how much time you have left, and there’s no point in going through any treatment, because you’ll be worse off in your final days than had you just let things run out and let nature take its course,’ ” he said.

A decade’s revolution in cancer care means a buffet of options: immune therapies, targeted therapies, chemo, surgery and radiation.

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The Cross Cancer Institute had 4,837 new patients in 2023, up 20 per cent from five years ago.

Population growth means more cancer patients; better care means more survivors, means more care. An oncologist shortage means delayed diagnoses and treatment, up to eight weeks to be seen by a medical oncologist, 13 weeks for a radiation oncologist.

Alberta has the lowest number of oncologists per capita across Canada, and salaries have fallen below competitiveness with other provinces and the States, say physicians.

If cancer isn’t addressed early, patients need more surgeries, more time in the hospital. That impacts Alberta’s bed shortage.

Andrea Smith, a spokeswoman for Health Minister Adriana LaGrange, recently told Postmedia that Alberta Health isn’t limiting the creation of new oncology posts at Cancer Care Alberta.

“Alberta Health has not capped the creation of net new oncology posts, nor have we capped the oncology budget,” she said, citing line items in Budget 2024, such as $108.5 million for the Arthur J.E. Child Comprehensive Cancer Centre in Calgary, $25.82 million for cancer research and prevention, and an increase in overall budget for cancer drug support.

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Between a doc and a hard place

John Graham
John Graham poses for a photo in his Edmonton home, Friday June 7, 2024. Graham is currently battling prostate cancer. Photo by David Bloom /Postmedia

John Graham was caught between a doc and a hard place.

Routine prostate blood work numbers got concerning in June 2023; he was referred to a urologist.

A month later, Graham recalled, the urologist told Graham he was on the old side for treatment.

With a mind sharpened by a long career in international commercial leasing, and spry at 80, Graham objected.

“I turned around and sort of insisted that I’m not that old. Maybe on the calendar, yes, but not physically or internally. I’ve got longevity in my family, an uncle that just passed away at 102, so I plan to keep my tires rotating for the next 10 or 15 years,” he said.

A month for a biopsy order.

Graham accessed his results, numbers heading upward.

Two weeks for the urologist to get back to him, a month to get on a three-month waitlist at the Cross.

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His primary physician retested, showing 30 per cent escalation.

With his son-in-law, Graham researched oncologists rated for responsiveness. He showed up at Debenham’s office last Christmas, tests in hand.

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Debenham called him back at home to say he needed immediate attention.

“That put the fire under my butt,” Graham remembered.

The urologist told him it was in the Cross’s hands.

An Alberta Health Advocate — who didn’t live up to their title, he said — told him to keep his place in line.

His MLA connected the dots to the Health Ministry, which directed him back to his place in line — ”one heck of a frustrating exercise,” Graham said.

He got in touch with the Cross, which moved treatment up after a cancellation.

His advice to cancer patients?

Be proactive, tenacious. Embrace technology, help yourself.

Seek help from those with authority and experience.

Ironically, Graham was told that had he sought treatment more quickly, they could have dealt with his cancer surgically, but because of delays, radiation and hormone therapies together were required — and that has played havoc with his “plumbing.”

Post-treatment, his prostate-specific antigen score, an indicator for prostate cancer, have gone from the emergent 17 to a stellar 0.1.

Graham has a list of medical angels to thank: Debenham, oncologist Dr. Adele Duimering, primary-care physician Dr. David Pickle, nurse Marie Kemp.

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“The people at the Cross walk on water. They have such a tremendous attitude, they’re very pro-patient,” he said.

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