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Results: 106 - 120 of 666
Mélanie Bélanger
View Mélanie Bélanger Profile
Mélanie Bélanger
2021-04-19 11:48
For colon cancer, we need funding specifically for endoscopy. For things to work, we will have to have more rooms and more staff. Yes, more investment is needed. Because of the size of the backlog that we are currently experiencing, the situation cannot be resolved by reorganizing work or services. We really need financial support. Gastroenterologists are available as needed to work more. We can do the work. What we need is access to secure and well organized facilities and additional payments for our specialized staff, whom we wish to keep.
Martin Champagne
View Martin Champagne Profile
Martin Champagne
2021-04-19 12:06
Good morning, Mr. Chair. I thank you and the members of the committee for your invitation.
I am going to discuss the impact of COVID-19 on cancer, a chronic disease with acute episodes of care over a long period of time. It is very different from single episodes of care such as orthopedic surgery for hip or knee replacement, or cataract surgery.
The postponement of medical activities has caused diagnostic delays that have major consequences. Indeed, a longer diagnostic delay allows cancer to progress, leading to an increased risk of relapse and a decreased chance of cure. For patients, the consequences are important since it will result in increased morbidity. As patients are sicker and are sick longer, the intensity of treatment required will have to be increased because the disease will be more advanced. The more advanced stage of the disease will also result in higher mortality. Because cancers are diagnosed too late, the impact of the pandemic will be felt for many years, both on patients and on the human and financial resources required by health care systems.
Three things need to be tracked: waiting lists, patients on those lists whose care has been delayed, and diagnostic delays, which are very telling of the real impact.
Let's talk about screening programs first. Patients with symptomatic illnesses come to the emergency room, are seen, and for the most part, are managed. That hasn't changed much. Screening programs, on the other hand, diagnose patients at early stages who do not have symptoms. It is estimated that screening programs can reduce mortality from detected asymptomatic cancers by 20% to 40%. This is because diseases discovered at early stages require much less intensive, easier care. They can be limited sometimes to simple surgery rather than requiring a combination of surgery and chemotherapy.
In Quebec, colon and breast cancer screening programs were shut down in the first wave of the epidemic in March 2020. It has not been possible to catch up diagnostically for these patient cohorts. I will provide data in a few moments.
During the previous sessions, Dr. Bélanger explained the strategy for screening for blood in the stool, occult blood, for colon cancer. Patients who test positive for blood in the stool will undergo colonoscopy, which sometimes reveals polyps, a lesion considered precancerous, or even colon cancer.
Presumably, we are seeing a significant reduction of about 28% in tests performed compared with the previous year. The cumulative backlog, despite the lull in the COVID-19 pandemic over the summer and early fall, has not been cleared. What is known is that the less screening that is done, the fewer diagnoses are made. There are not fewer cancers, it's just that they haven't been screened.
In care-delayed patients, there is less occult blood screening and the number of patients who are found to have blood and to whom we want to offer colonoscopy has increased. So the care-delayed patients represent significant numbers, on the order of about 152% if you look at the entire cohort.
In Quebec, about 800 fewer colon cancer surgeries were performed this year than at the same time last year. Dr. Bélanger noted that this cancer is the third leading cause of cancer death in Canada. So this is something that has important consequences. Indeed, as the cancer progresses, surgery may become pointless and one must then turn to chemotherapy or radiation therapy.
These observations are essentially the same for breast cancer, where screening is down 30%, so at 70% of the previous year's level. There are far fewer patients diagnosed with the disease at an early stage. For Quebec as a whole, there is currently a reduction of about 22% in the number of biopsies confirming the diagnosis of cancer, the biopsy being the first step in the confirmation of a cancer. This means that for approximately 60,000 new cancer diagnoses annually in Quebec, there is a cancer diagnosis deficit of approximately 10,000 people.
As a result, there are significant delays and timelines for many oncology surgeries are not being met.
In conclusion, we really need to be concerned about these delays, because patients and society will pay the price. For 13 of the 17 cancers that were studied, a four-week delay in diagnosis increased the risk of mortality by 6% to 8%.
For colon cancer, each four-week delay in diagnosis increases the risk of mortality by about 6%. For breast cancer, the increase is 8%.
British epidemiologists estimate that the mortality rate for cancer patients could be as high as 20% in the next year, but that the price to be paid could extend over 10 years. Indeed, there could be 10% excess mortality per year for the next 10 years.
To solve this problem, we must preserve human resources. As Dr. Belanger mentioned to you, we need significant additional investment to ensure that we have the human and material resources to provide the therapies that patients need.
I have appended several charts that come from the Quebec Ministry of Health and Social Services that give examples of delays in diagnosis and delays related to the various tests that I mentioned.
View Larry Maguire Profile
CPC (MB)
Thank you, Mr. Chair.
I want to first go to Dr. D'Angiulli, just to look at the best ways....
You talked about the delay in medical screenings and interventions. There are delays in all ages, I believe you said.
Can you give us your impression of how this compares with other countries? I guess that's one of the biggest issues I'd like to know about. With regard to the delay in medical screenings, you say there's help for teachers and that sort of thing in those areas in your presentation that you gave us today.
Can you elaborate on how that compares in Canada with other countries and what context they have for reopening?
Amedeo D'Angiulli
View Amedeo D'Angiulli Profile
Amedeo D'Angiulli
2021-04-19 12:24
Canada is doing much better than countries like Italy, and this I can tell you from own experience. One of the things that Canada is doing very well is managing the online environment better than other countries.
However, we are, I would say, better and worse. It's a relative term. To be clear, we are lagging behind some of the Scandinavian countries, for example, and other countries like Australia and New Zealand.
The approach that most of the countries in the EU are taking, for example, is to enhance the online environment to give schools and parents more contact and to change the way that schools operate with the input of the students and parents. What they have done in Scandinavian countries is to reduce class sizes to have more one-to-one time, redefined spaces for physical activity and other things, which is critical right now, because play and socialization in young children, for example, is vital. You cannot replace it online.
My 3-year-old sits at a computer like a zombie. She doesn't really engage with the media. You need some form of engagement that is person to person.
We can do it. As a country, we have the ability and the skills. We have some of the best schools in the world. However, we are still not quite getting it.
Compared with other countries that don't have resources, of course, we are doing much, much better.
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-04-19 12:38
Thank you very much, Mr. Chair.
I would like to thank all of the witnesses for their insightful testimony. Their contributions will surely help us to make important recommendations.
Dr. Champagne, thank you for your presentation, which was very clear. It was so clear that it is chilling. What you are telling us is that over the next 10 years, there will be a 10% increased risk of mortality.
There is no medical care without diagnoses. Still, when it comes to cancer, the diagnosis must come in time. Screening is therefore crucial in the fight against this disease. Yet, currently, patients who do not have COVID-19 are bearing the brunt of this pandemic, just as patients who do have COVID-19.
However, we weren't talking about it much, we weren't talking about it enough. If we want to find solutions, we still need to have a diagnosis and a clear picture of the reality. What we understand from your testimony is that the pandemic has had two effects in terms of costs. First, it requires additional, one-time costs to address the pandemic, but it will also cause further increases in system costs because of undue delays and postponements.
The underfunding was there before the first wave. We are in the third wave, and there is no guarantee that there will not be a fourth.
Are you concerned? What should be done?
Martin Champagne
View Martin Champagne Profile
Martin Champagne
2021-04-19 12:40
I am very concerned.
Let's take the example of colon cancer—it always comes back to that example. If you have stage 1 disease, which is very localized, surgery will put an end to the episode. You have an 80% chance of cure, and after that, it's over.
However, if the disease has started to spread into the lymph nodes, which are like filters around the tumour, and the disease is now in stage 3, you will need additional chemotherapy for a period of about six months. There are costs associated with that, and there is certainly increased morbidity for patients, as they have to endure the effects of treatment. The chances of recovery will be less: at best, it will be 50% to 65%.
This means that a large number of patients, one-third to one-half of them, will eventually relapse and return to the health care system for other equally costly therapies that will require human resources. The physical resources exist, the hospitals exist. We can always imagine revamping hospitals, but we know that antineoplastic treatments, cancer treatments, cost tens of thousands of dollars per episode of care for a patient.
These are health care system costs that will be recurrent for many years. Relapse does not necessarily occur in the first few months after the initial diagnosis, it can occur, two years, three years, five years, or even 10 years later. This imposes a human burden on the patients, who will suffer more, but also on the entire health care system, which will necessarily have to make major investments in human and material resources.
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-04-19 12:42
Dr. Belanger was telling us that a colonoscopy costs $1,000. The patient who does not have timely access to a colonoscopy will end up with a chronic health problem and become dependent on the health care system over many years. You are telling us that it will not only cost a lot more to maintain the quality of life of such a patient, but it will also create other costs for the health care system. So we have to expect an increase in the cost of services in the health care system right now if we are going to treat these people. Yet we do not currently have the resources to care for them.
Martin Champagne
View Martin Champagne Profile
Martin Champagne
2021-04-19 12:43
The already very limited resources are running out. Even during the lull we experienced between the second and third wave of the COVID-19 pandemic, we were never able to exceed the maximum activity level of 100%. As a result, we never erased the diagnostic delays that jeopardize our patients.
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-04-19 12:58
Thank you, Mr. Chair.
Dr. Champagne, thank you for taking the time to come and give us a picture of the situation. It is very enlightening.
I have a quick question. Since the first wave, have you or your colleagues been able to identify any patients who have had less treatable cancers because of treatment delays?
Martin Champagne
View Martin Champagne Profile
Martin Champagne
2021-04-19 12:58
Every week, we see patients coming in with cancers that are more advanced than they would have been if those patients had been diagnosed when their symptoms were starting or if they had been screened.
As a result, this is, unfortunately, a daily occurrence for oncologists. This situation does not occur only in Quebec. Some provinces were less affected than ours in the beginning, in the first wave and in the second wave, but when you read the newspapers today, you see that the same scenario is happening all over Canada.
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-04-19 12:59
So the catastrophic situation that Ontario is currently experiencing should also have a fairly catastrophic effect on Ontario patients.
Sean Bruyea
View Sean Bruyea Profile
Sean Bruyea
2021-04-14 16:22
Thank you very much, Mr. Brassard.
To that end, I submitted a 40-page report with 53 very substantive recommendations. Why? We've been looking at this problem.... For me as an advocate, not much has changed in 20 years in the way the department deals with veterans with psychological injuries. Yes, they've advanced vocational rehabilitation. Yes, they've helped veterans with minor injuries and minor disabilities, but they still cannot bend their heads around the lifelong commitment of care that is necessary for veterans with psychological disabilities who inherently have complex needs.
A perfect example of that is what's called the POC 12 mental health care policy. It says all veterans with complex needs, with mental health problems, will receive case management. Only a quarter of veterans with mental health disabilities are actually receiving case management.
It goes beyond that. Veterans Affairs starts with a paradigm. The veteran comes to them and the veteran's asking, “How can we as a family deal with this?” Veterans Affairs' answer to that is “How can we as a department deal with this?” That is a fundamental paradigm distance that is miles wide that Veterans Affairs doesn't know how to meet. We have to start from the top down and the bottom up, and we have to have a fundamental rethink about how this department works.
Right now the department is structured so that the organizational tools of the department are co-opted by selfish career progressions of the most senior managers. They may be well meaning, but they are 20 degrees removed from the actual reality of what veterans and their families live. We really need to completely rethink this department.
First of all, it has to be taken out of Charlottetown. It's the only federal department that exists outside of Ottawa. It is far from oversight agencies, far from the culture of veterans and their families, and it's been allowed to have a 40-year culture of basically disconnecting itself from not just veterans and their families but Canadians in general. This department is hypersensitive to criticism.
We have to start. I would suggest some number one things that can be done. We have to have an oversight agency that can check in on the department, an ombudsman who is legislated, who has the power to decide their own agenda of investigation.
On top of that, we have to have appointment bodies of advisory groups that are completely independent, not stacked with Veterans Affairs bureaucrats. The board of directors could report to committee, to Parliament, and that board of directors would be a wide swath of Canadians who would independently review the actions of senior leadership.
At the level of working with veterans, we need a collaborative care management program that has independent practitioners, so that every veteran who has a mental health injury is assigned an independent, contracted primary care doctor. The team would consist of a doctor, independent case manager and an occupational therapist.
Veterans Affairs would exist to merely implement all the care and treatment that is recommended by this team. Veterans Affairs would not exist to scrutinize these requests, but would exist to train the senior bureaucrats to learn what veterans need.
To that end, senior bureaucrats should be manning the front lines at least one week a year. They did this with Service Canada back in 2000, and it worked amazingly. Unfortunately the rest of the bureaucracy didn't like the idea of directly serving Canadians as senior bureaucrats at the front line, but we can reinstate that with Veterans Affairs.
View Marc Serré Profile
Lib. (ON)
View Marc Serré Profile
2021-04-08 12:17
Do you feel there are major gaps in the services offered in French? If so, is it in victim services or in services in general?
Can you elaborate on the support offered in French to victims?
Stéphanie Raymond
View Stéphanie Raymond Profile
Stéphanie Raymond
2021-04-08 12:17
I am going to try to choose my words carefully.
As a francophone, I have experienced discrimination during my career. It happened especially when I was working in the regular force at Valcartier, even though the city is predominantly francophone. I experienced discrimination from a medical standpoint. When I called the ombudsman, for example, I had to call back later or wait for someone who spoke French to call me back. In the end, no one could serve me in French, and I had to manage in English. Often only one French speaker was working per shift and they had to serve all of the Canadian Armed Forces.
Results: 106 - 120 of 666 | Page: 8 of 45

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