Staff shortages add challenges for cancer care patients in area

Washington County has the third highest rate of cancer diagnosis per year in the state, according to the U.S. Centers for Disease Control and Prevention, with an average of 258 new cancer cases diagnosed annually. The closest and most widely used cancer care treatments taken by the county's residents, such as radiation and chemotherapy, are found in Brewer and Bangor and have been for years. Therefore it was a shock when family nurse practitioner Christine Moulton, who works for the Regional Medical Center at Lubec in the East Machias office, heard at the end of August from the Lafayette Family Cancer Institute in Brewer that they could no longer take new referrals for cancer care. When alerted to the issue, Senator Marianne Moore of Calais shared her alarm, calling it "a grave situation."
"I have worked in Washington County for 24 years," Moulton says, "and we have never had this kind of gap in cancer care." She comments, "We were advised to send patients with cancer to MaineHealth Cancer Care in South Portland, Pen Bay Cancer Care in Rockland, New England Cancer Care Specialist in Topsham or Hematology-Oncology Associates in Lewiston." She adds, "When I first heard about it, I was walking around in a daze asking myself, 'What are we going to do for our people?'"
Of the patients Moulton cares for with cancer, she says that 99% of those who receive chemotherapy and/or radiation have gone to the Lafayette Family Cancer Institute. The drive from Washington County to Brewer and Bangor can be anywhere from two hours or quite a bit more depending on where the patient lives, and that is just one-way, she points out. "This not only represents a crisis for Washington County residents but all Maine residents north of Waterville."
Alerted by Moulton, Moore contacted Lafayette's parent company, Northern Light Health, and Maine Health and Human Services Commissioner Jeanne Lambrew. After speaking with Northern Light Health CEO Tim Dentry, Lambrew shared that the concern is "universally shared. The loss of several providers and inability to hire at Northern Light Health has led to an extremely limited ability to accept new patients; they do accept some new patients such as inpatients who are newly diagnosed with cancer and patients needing concurrent radiation and chemotherapy. They expect that new hiring and use of contract staff will expand the system's ability to treat oncology patients ... and they plan on reopening this service line to all new patients in November. That said, in the short run, the Northern Light Health team is aggressively working with other state providers to fill in the gap."
Northern Light Health Senior Communications Specialist Kris Currier says, "In addition to facing a national shortage of medical oncologists, at Northern Light Cancer Care we are experiencing an unusually high volume of new patient referrals." She adds, "We continue to schedule patients for radiation and surgical oncology appointments, and we are partnering with referring providers to assist in navigating patients to the appropriate level of care, either at Northern Light Cancer Care in Brewer, at Northern Light AR Gould in Presque Isle or another cancer program."
For the longer-term goal of building the healthcare organization's workforce, Currier explains, "In the coming months, we look forward to welcoming several new providers to Cancer Care, and we will be launching a nurse navigation program to support our oncologists and streamline our patients' care journeys. To move through this short-term process change, we have contracted with a staffing agency to bring in physicians who will work with us temporarily while we recruit new, permanent physicians, and hope to accept all patient referrals in the near future."
Northern Light Health is working on a number of steps to ameliorate the cancer care provider shortages. Currier provides an outline. A new nurse navigation program is being developed, with three navigators hired and the goal to have it up and running by early 2023. The navigators will provide support and care coordination for patients in Northern Light's service area.
Currier explains, "Oncology nurse navigators and oncology patient navigators support patients with cancer, their families and their caregivers to assist them in overcoming any barriers they may be facing in the healthcare system and facilitate timely and quality access to care through all phases of the cancer journey."
Northern Light Health does provide telehealth services to patients when appropriate, Currier says. Moulton notes that in her experience much of the cancer care treatment plan creation could be done by telemedicine. She queries whether they "have they used all possible telemedicine options and explored all possible collaborations with other cancer care" facilities and partners.
Northern Light sees about 2,500 new hematology and oncology patients per year, with close to 8,500 unique individuals in medical oncology in 2021. This is a 15% increase in number of patients since 2019, Currier says. "We provided approximately 77,000 visits in medical oncology in 2021, which is 10% more than provided in 2019. Close to 20,000 of those were cancer infusions. We've seen a 9% increase in the number of new patients needing radiation oncology during that same time frame."
In the long-term, Northern Light Health is focusing on retaining its skilled providers and caregivers throughout the state. It partners with colleges and universities throughout Maine and the nation to develop new nurses, physicians, pharmacists and other clinical staff who make up its care environment. In addition, it offers internal and external classes to people who are interested in becoming medical and nursing assistants, and tuition assistance and scholarships are available to most of its staff. Currier adds, "We also work collaboratively with state agencies to address the critical shortage of care givers."
In her correspondence with Senator Moore, DHHS Commissioner Lambrew said, "We can help with transportation for MaineCare members. I'll raise the concern with the Maine Hospital Association this week and see if there are other short-run options. And I'll ask the healthcare workforce team if we can track oncology training within the $20 million Maine Jobs & Recovery Plan spending for the long-run."
Moulton has sharp words about the training option. "That sounds like a pipe dream." The need is now, she stresses, and she references the many years it takes for oncologists to receive their medical training.
Senator Moore says, "I will continue to monitor this situation and do everything within my abilities to be sure we continue to have access to this critical care. I would love to see us work towards having an oncologist available locally at one of our hospitals," although given the shortage of healthcare practitioners in the field, she understands what a long-shot this dream may be.