HAMILTON — Access to cancer surgery in Canada and the odds of dying from it depend on where you live, concludes a hard-hitting report by Hamilton researchers.

The likelihood of getting life-saving surgery is double in some provinces, found the 176-page study released Thursday by the Canadian Partnership Against Cancer (CPAC).

Postoperative death rates are up to four times higher between provinces for ovarian, lung, liver, pancreas and esophagus cancer.

"I was pretty shocked," said lead author Dr. Christian Finley, a thoracic surgeon at St. Joseph's Healthcare and McMaster University. "We showed really tremendous disparity. This is unacceptable."

The first-time look at high-risk cancer surgery across Canada raises alarm about the lack of oversight and evaluation in most provinces. For the most part, there is little regulation of how frequently a hospital or surgeon needs to perform a procedure to maintain their skills.

"Despite the significant role of surgery…cancer surgery management is largely not integrated under the umbrella of provincial cancer agencies," states the report. "This results in a lack of accountability in most of the country and an inability to enact change or to initiate a formal process to track and evaluate outcomes."

There are no national standards for cancer surgery. Ontario has the most evidence-based guidelines and is willing to share its knowledge, but the province still falls short particularly for ovarian cancer.

"There is a need to develop standards at a national level," said Dr. Geoff Porter, a cancer surgeon at Capital Health and Dalhousie University in Nova Scotia as well as an expert lead with CPAC. "What this paper shows is that doesn't exist."

The lack of oversight comes at a high cost, particularly for patients going to hospitals doing a low number of procedures. The report found every 10-case increase in volume reduced the risk of death by about 20 per cent for esophageal and pancreatic cancers.

It's a particular issue in ovarian cancer, which has half as many cases as lung cancer but triple the number of hospitals performing operations nationally, resulting in very low volumes in some centres.

"They don't know they have a problem," said Finlay about hospitals with higher mortality rates. "There needs to be regulations of who can do what and where."

Cancer Care Ontario has centralized surgeries to fewer centres so the teams do higher volumes and have better results.

"Ontario has done more in this area than other jurisdictions," said Dr. Robin McLeod, vice-president of clinical programs and quality initiatives. "We have improved care."

But variations persist within the province, found the report, showing more work needs to be done.

"We still have disparities in care," said Finlay. "There are still big differences."

Cutting the number of hospitals doing high-risk cancer surgeries means patients travel farther for treatment, but focus groups in Hamilton, Edmonton and Charlottetown found people are willing to be inconvenienced for higher-quality care.

The report recommends limiting the amount of travel required through partnerships between big-city and small-town hospitals, satellite sites such as the Walker Family Cancer Centre in Niagara and new ways of treating patients like St. Joseph's integrated comprehensive care project.

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Making these changes can save money as well as improve care. The report found average hospital stays vary by up to 30 per cent depending where the surgery took place.

In Saskatchewan, pancreatic cancer surgery patients stay an average of 14 days in hospital compared to nine days in Ontario.

The report estimates nationally, 4,775 hospital days a year could be saved with better regulation of cancer surgery.

"Surgical cancer care is facing particular challenges, with rising incidence rates for most cancer and an aging population increasing the demand for these surgeries," states the report.

The need for a detailed national database on cancer surgery is evident as it took two years for the Hamilton researchers to compile and analyze the information.

"It's absolutely critical if we're going to make strides. We have to be able to assess how we're doing," said Porter. "We need to develop data that can be accessed much quicker. We have to be able to measure things in a more effective way."

The report urges action, saying the disparities in surgical care between provinces "necessitate attention." The first recommendation is appointing a lead for surgical cancer care in each province.

"The significant variance in how surgical cancer care services are delivered between the provinces greatly impacts patient survival, efficiency of the health system itself and how well patients can access care," it states.

The Hamilton researchers will present their results Nov. 27 to cancer agencies. They have already started sharing their findings with surgical specialist associations and provincial bodies.

"It's getting attention," said Finlay. "People are taking it seriously."