To improve cancer outcomes for all Canadians, we must ensure that research and advanced care reach every community — not just those close to major centres.

*By Suzanne Campbell 

Receiving a cancer diagnosis is a life-changing moment, regardless of where you live. But for people living in rural or remote areas, there are extra challenges — particularly for people living in rural Indigenous communities. 

Imagine having to travel long distances, often alone, to get specialized care. Imagine having to leave your home, your family, and your community to receive treatment. Imagine having to navigate through the emotions and uncertainties of cancer care, while being in an unfamiliar and overwhelming new city.  

Imagine knowing that if your family member lived in an urban city, they would have more options for treatment and better access to new trials and research. Imagine wondering if they could have lived longer if you lived somewhere else. This is the reality that we live with in rural areas; however, there have been significant improvements in the past two decades, and exciting changes are having positive impacts. 

I have been a family physician for 20 years in Vanderhoof, a small community in Northern BC located about 100 km west of Prince George. For the past five years, I have also worked with Carrier Sekani Family Services to provide primary care in the Saik’uz First Nation. During this time, significant progress has been made in the quest to bring cancer care closer to home and to increase access to research and trials for rural patients.  

BC Cancer has a unique and successful approach to bringing cancer care closer to home: they offer a GPO (General Practitioner in Oncology) education program for family physicians and nurse practitioners. This program provides knowledge and skills and helps participants foster relationships with cancer care specialists and tertiary care cancer teams, preparing primary care clinicians to work in rural and remote areas of the province to improve cancer care. 

After completing the GPO training in 2007, I joined the Community Oncology Network (CON) clinic in Vanderhoof, which began providing systemic therapy — including chemotherapy — in 2008. As a rural GPO in a CON clinic, I work with our team of nurses, and other GPOs, to deliver systemic cancer treatment to people who live in Vanderhoof, as well as in multiple rural communities in the surrounding areas. This includes many remote Indigenous communities. We also assist our primary care colleagues in navigating some of the challenges of the journey to a cancer diagnosis in rural communities. We help to fast-track access to care when needed, and assist with symptom management and end-of-life care.  

Through my experience as a rural primary care physician and a rural GPO, I’ve witnessed firsthand how receiving cancer care closer to home makes a huge difference in my patients’ lives and their families' lives. 

Our CON clinic allows people receiving cancer care in our area to stay at home with their families and support networks. Previously, when faced with the prospect of regular long-distance travel or long-term absences from home, many people diagnosed with incurable cancers in rural or remote communities chose to forgo treatment, opting instead to receive palliative symptom management closer to home. With a CON clinic like ours, more people have the option to receive palliative chemotherapy without having to give up time with their family, allowing them to benefit from treatment that can potentially prolong and improve their quality of life. 

In addition to cutting down on travel, community oncology clinics also provide a unique approach to care. Compared to tertiary cancer centres that have large buildings and large teams of people, the patients treated at our centre quickly know every team member, including our unit clerk, nurses and GPO physicians. It really becomes a ‘home’ for them within the bewildering behemoth of the complex cancer care system. For people who are not used to travelling to “the city” — whether Prince George or, even more intimidatingly, Vancouver — receiving care closer to home from familiar physicians, nurses and staff can feel much more comfortable and less stressful. 

People who live in rural and remote areas of Canada not only face additional geographic and cultural barriers to standard cancer care but also have fewer opportunities to participate in research and less access to cutting-edge therapies and technologies. Preventing people from participating in research not only denies them the potential clinical benefits of the research, but also undermines the quality of the research itself. To create equitable solutions, cancer research must include and represent all the people and communities that it aims to benefit. 

Fortunately, there is progress in this area as well. For example, over the past two years, I have referred several patients to the Personalized OncoGenomics (POG) program led by BC Cancer and the University of British Columbia. This has enabled patients from a remote Indigenous community and a rural community north of Vanderhoof to receive personalized treatments tailored to the unique genetic characteristics of their tumour. 

In nearby Prince George, the Northern Biobank Initiative (NBI) and the associated Indigenous-governed Northern BC First Nations Biobank are also creating opportunities for patients to donate their biological samples for research. As the first known community-hospital biobank in Canada, the NBI is an innovative program redefining how research participation is approached in Northern BC. 

Both the POG program and the NBI are supported by the Marathon of Hope Cancer Centres Network, which is actively expanding to include more community-based cancer centres across Canada. By uniting research institutions and hospitals spanning from community clinics in remote communities to world-class universities in our country’s largest cities, the Network is bringing together people with a wide range of expertise, knowledge and experiences. Working together is how we will improve cancer care and research for everyone, no matter who they are or where they live. 

I’m proud to work within the CON community in Northern BC and be a part of networks that are leading the way in bringing cancer care closer to home for rural communities and increasing access to research initiatives. I’ve seen the power of community relationships and local efforts that are a key part of optimizing cancer care outside of tertiary care cancer centres. The history of being left out on the periphery of the cancer care system is changing, and I’ve witnessed the profound effect that this can have, from increasing screening and identifying cancers earlier to improved treatment options and better quality of life during end-of-life care. 

Of course, there’s still a lot of work to be done. Patients in rural and remote areas still have poorer cancer outcomes than those living near big cancer centres. But these changes are starting to make a difference — and I’m excited to see how innovations and better connections will help shape the future of cancer research and cancer care for those of us who are lucky enough to live in the beautiful rural and remote communities across the North. 

*Dr. Suzanne Campbell is a family physician with a specialization in oncology and Indigenous primary care. She lives and works in Vanderhoof, BC.