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Heal, Britannia: U.K. gets cancer care right

Not long ago, it had the worst cancer-fatality rate in the industrialized world. Now, Britain shows the way forward for Canada's own fledgling cancer strategy. ANDRÉ PICARD reports from London

From Saturday's Globe and Mail

LONDON — John Dobson prides himself on the healthy lifestyle that has left him lean and fit at 70. He is an avid walker and non-smoker. He eschews the greasy, meaty British diet in favour of one rich in fruits and vegetables. And he lives in one of the most pristine parts of England so he can breathe the fresh sea air.

So when he received an invitation from the British National Health Service to participate in a bowel-cancer screening program, Mr. Dobson was only too happy to join in. An avid diarist, he noted it in the black, spiral notebook he keeps handy. Little did he know it was the beginning of a life-altering journey.

Luckily for Mr. Dobson, the cancer journey in Britain has a good road map, with clear goals, standards and wait guarantees. Diagnosis and treatment are done quickly, and the quality is excellent all over the country.

It is a model this country hopes to emulate with the Canadian Strategy for Cancer Control, details of which were unveiled yesterday.

For those who wonder what another bureaucratic structure and plan can achieve, Mr. Dobson's story is illustrative and inspiring. It also suggests where Canada has yet to go far enough.

A retired gas-company worker in North Walsham, a pretty former mill town northeast of London, Mr. Dobson dutifully completed the fecal occult blood test -- which detects minute traces of blood in stool -- and mailed it off on Sept. 6. "It's a messy affair, but easily got over," he says with a laugh.

A week later, a letter arrived, saying test results were "abnormal" and urging Mr. Dobson to undergo a colonoscopy. He met with a nurse to discuss the procedure and booked an appointment.

On Sept. 29, he underwent a colonoscopy, watching the test -- in which a flexible, camera-equipped tube is guided into the colon as a means of looking for potentially cancerous polyps -- on a video screen. "Some people would be squirmish, but I was fascinated."

Fascination turned to fear when the gastroenterologist, snaking the tube around the bends, arrived at the caecum, the pouch at the beginning of the large intestine, where he detected a large growth.

"The good professor said it looked malignant," Mr. Dobson recalls. "Cancer."

Laboratory tests confirmed the unexpected diagnosis a few days later. A CT scan (a 3-D X-ray) showed the cancer had not spread beyond the bowel.

On Oct. 12, Mr. Dobson met with the oncology surgery team.

After a discussion of his options, he booked a date to go under the knife. On Oct. 23, at Norfolk and Norwich University Hospital, about a third of his bowel was removed.

Leafing through the diary, he notes that the whole process, from simple screening test through to complex cancer surgery, took only six weeks. It is a speediness of care Canadians can only dream of.

Moreover, he was accompanied through the entire cancer journey by a single nurse, ensuring co-ordinated, consistent, quality treatment. Her role was to serve as an educator and an advocate as Mr. Dobson tried to navigate the complex health system.

"She guided through every step and answered every question. There was no bull about it," he says. "I can't fault anything at all in the process. It was brilliant."

In fact, his experience is a textbook example of the type of patient-centred care the British NHS set out to provide when it drastically overhauled cancer services.

Now, it is Canada's turn, responding to a rising clamour for reform. The task falls to the country's new cancer czar, Jeff Lozon, the president and CEO of Canada's foremost cancer hospital, Princess Margaret.

The details unveiled yesterday, seven years in the making, include a new independent agency, called the Canadian Partnership Against Cancer, will oversee research, prevention and treatment. But its role will remain advisory, with provinces (and Ottawa to a lesser extent) maintaining control over delivery and responsibility for funding.

In a country where cancer care is oft-described as our national shame, the partnership has its work cut out for it. But so too did Britain.

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