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As the world deals with a global pandemic, MSH’s cancer clinic hasn’t missed a beat

By Vawn Himmelsbach

In 2015, after visiting her doctor about a pain in her side, Eileen Russell was diagnosed with Stage 4 breast cancer that had metastasized to her bones. At the time, the diagnosis was grim: her cancer could not be cured. But it was treatable — so long as she continues to have chemotherapy every three weeks for the rest of her life.

As cancer treatments improve, so does the quality of life for patients. “It definitely is an incurable cancer but I’m so happy it’s treatable,” says Eileen, who has responded well to treatment and lives a relatively normal life.

Even a global pandemic has not slowed her down, since she’s been able to continue to receive first-class care throughout the pandemic at The Shakir Rehmatullah Cancer Clinic at Markham Stouffville Hospital (MSH).

“The number one thing for me was the fact that they did not cancel any of my treatments [because of the pandemic] — not one,” says Eileen, a former MSH employee who was hired in 1989. She was the hospital’s man­ager of communications when she retired in 2013.

Because of COVID-19, Eileen has not been able to visit with former colleagues while she’s in the hospital for chemotherapy. She misses that, but she was delighted to be able to continue regular treatments with oncologist Dr. Henry Solow and her nurses, Debbie, Heather and Sinny.

Patients like Eileen who require ongoing care through The Shakir Rehmatullah Cancer Clinic become “like family,” says registered nurse Debbie Mahoney, who has been one of Eileen’s nurses since the initial cancer diagnosis. “So that part hasn’t changed [because of COVID-19].”

What has changed is that Eileen’s husband Jim (or any other visitors) cannot sit with her during treatment, due to safety protocols at the hospital. “Prior to COVID-19, Jim came with her every single time,” says Debbie. “We would have a nice chat. It’s a small clinic and it’s very personal, so you get to know the patients and their families. We exchange Netflix options and talk about travel; it’s a family kind of feel in here.”

At The Shakir Rehmatullah Cancer Clinic, MSH’s oncology nurses help patients through each step of their journey. The clinic includes the innovative pain and symptom man­agement clinic, which is expanding its services thanks to donor support. Through an integration of acute and palliative care, patients receive treatment that goes beyond their cancer diagnosis, encompassing related complications as well.

During the pandemic, oncology nurses are doing whatever they can to ensure vulnerable patients continue to receive the safest, most efficient care possible. For example, there’s now a separate entrance for oncology.

“It’s been amazing. You get screened there, you get your hand sanitizer and mask and temperature taken,” says Eileen. “Everything is done right at that entrance so it’s an extremely safe environment.”

MSH’s oncology program — which includes the Breast Health Centre, chemotherapy clinic, pain and sym­ptom management clinic, colon health services, clinical trials and radiation consultative services — was created in response to demand from area residents who want cancer treatment close to home, in their own community.

“Oncology is an essential service, so plus or minus COVID-19 we forge ahead,” says Cheryl Osborne, patient care director of emergency services and ambulatory care. But dealing with a pandemic brought with it extra challenges for oncology.

“It takes longer to provide care when you’re donning PPE and disinfecting surfaces in between patients,” says Cheryl, “and that will remain a challenge until we’re past the pandemic.”

There’s also a backlog of patients who did not come in for checkups during the height of the pandemic. “They’d only come to the Emergency Department if they were really sick,” says Debbie. “So the patients we’re getting now are really sick, and they’ve been sick for a while.”

But the pandemic is not the only challenge. As the community continues to grow, so too does the need for cancer treatment and support. MSH has been experiencing a 12 per cent annual increase in new oncology consults within recent years, currently treating upwards of 30 chemotherapy patients daily. Most days every consult room and all 14 chemotherapy treatment chairs are full, and the clinics are operating at capacity.

This is not expected to slow down anytime soon, even when the pandemic is over. Indeed, nearly one in every two Canadians is expected to be diagnosed with cancer in their lifetime.

In its 2020 research, Cancer Care Ontario predicts an estimated 91,946 new cases of cancer in Ontario this year — that’s 252 new cases every day. The most commonly diagnosed cancers will be breast, followed by lung and prostate cancers. As Ontario’s population grows and ages, the annual number of new cancer cases is predicted to increase by 25 per cent in the next 10 years (or by 23,000 cases).

While more people are being diagnosed with cancer, more people are surviving and requiring follow-up care, sometimes for the rest of their lives — like Eileen.

There are dozens of chemotherapy drugs available and many more being developed. Eileen, for example, is being treated with two types of chemotherapy drugs as part of her maintenance plan. This does not ‘treat’ the cancer, but blocks it from spreading.

“New drugs are coming out all the time — it’s not necessarily a death sentence anymore, it’s almost like a chronic illness,” says Debbie. That’s one of the reasons why MSH is quickly outgrowing its current space in the cancer clinic.

In the near future, there will be a growing need for consults, acute patient care and longer-term palliative care.

“The clinic space for now is adequate to meet our needs, but we’re going to be pretty tight [as it grows],” says Cheryl. “Another four to five chairs will be needed within the next few years. Right now, we have to be creative with our schedule to ensure we can book the maximum number of patients, and while maintaining our COVID-19 practice and safety principles.”

Aside from more chairs, Cheryl expects they will need more infusion pumps and treatment room space, as well as the infrastructure required to support those additional spaces. She would also like to hire another nurse practitioner, as well as a second nurse navigator (someone who patients can contact when they need support).

“I would love to see an environment that’s more soothing and less institutional,” says Cheryl. “We’re doing that in the Breast Health Centre; there will be wall-to-wall graphics of nature scenes.”

In an effort to improve the overall patient experience including efficiency and patient flow, the Breast Health Centre relocation and cancer care expansion are now underway. The current Breast Health Centre space is shared with the chemotherapy clinic, so the relocated site will house larger assessment spaces and therapeutic intervention rooms.

The waiting room will also be segregated, providing patients with privacy and supporting best practices recommended by Cancer Care Ontario. Donor funds made the addition of specialized beds possible, as well as provided the furniture to support a more therapeutic and comforting environment.

Creating more dedicated space for surgeons at the Breast Health Centre will also allow for a much-needed expansion of the chemotherapy clinic, the symptom management program and the clinical trials program, as well as provide space for the radiation oncologist. With the acquisition of a tissue microarray processor for the lab — also thanks to generous donor support — MSH is well-positioned to grow its clinical trials program, particularly breast cancer trials.

“We’re anticipating by the end of spring we should be able to move into this new space,” says Cheryl. “We’ll be able to standardize practices across providers, so everybody’s experience will be similar in terms of intake and how we deliver services, allowing us to provide a better patient experience.”

As cancer treatments improve and more people live longer lives with cancer as a chronic illness — rather than a death sentence — there’s also a need for enhanced long-term support programs close to home.

Eileen is one of those patients who will benefit. However, in the meantime, while the world deals with a global pandemic, she has found that patient care at MSH has not missed a beat.

“As a patient I’m not really affected. I get my juice and cookies, and all the friendliness of the staff — apart from not getting my hugs,” she says. “[My husband] Jim is missing it big time because he’s the one who gets more hugs than I do, and they’re missing him too. It’s such a comfortable feeling, I kind of forget why I’m there.”

Article from Healthy Together Markham Stouffville Fall 2020/Winter 2021 magazine.