This holiday season, as we reflect on what we’re grateful for, I’m reminded of something that struck me while supporting my mom through her pancreatic cancer journey. Sitting in waiting rooms, we met so many people who drove three hours or more—just to access the same treatment she received close to home. It was a humbling reminder of the inequities in our healthcare system. While pancreatic cancer is a devastating diagnosis no matter where you live—with a 5-year survival rate of just 10% nationally in Canada—the challenges can vastly differ depending on your postal code. Let’s acknowledge the privileges many of us in larger provinces might take for granted.
Understanding the Bigger Picture: Geographic Inequity in Cancer Care
Why does location matter so much in cancer care? The answer lies in how healthcare infrastructure is distributed across Canada. In larger provinces, specialized cancer centers, clinical trials, and multidisciplinary teams are readily available. In smaller provinces and rural areas, patients often face geographic isolation, limited specialist access, and significant travel burdens.
Here’s what the data shows: Rural Canadians are served by only 8% of physicians in Canada despite making up 18% of the population. This disparity directly impacts cancer outcomes, particularly for aggressive cancers like pancreatic cancer where early intervention is critical (source).
1. Specialized Pancreatic Cancer Clinics
What does specialized care look like? In larger provinces like Ontario and British Columbia, patients have access to dedicated pancreatic cancer clinics or broader gastrointestinal cancer centers with oncologists who specialize specifically in this disease. These specialists understand the unique challenges of pancreatic cancer treatment and stay current with the latest advances.
The reality in smaller provinces: Patients often rely on general oncology services that may lack specific pancreatic cancer expertise. Without access to specialists, patients receive less personalized treatment plans and miss out on nuanced care strategies that could improve outcomes.
2. Access to Clinical Trials: A Game-Changer Disappearing with Geography
Why are clinical trials so important? They offer patients access to potentially life-extending treatments before they become widely available. For aggressive cancers like pancreatic cancer, clinical trial participation can mean the difference between limited conventional options and hope for improved survival.
The stark reality: Dr. Omar Abdelsalam’s research from the University of Alberta found that clinical trials are overwhelmingly concentrated in urban centers. Vancouver had 14.66 cancer trials per 10,000 people, while Canadian territories had zero. As Dr. Abdelsalam explains: “Clinical trials are an integral part of cancer care. It’s not a luxury or add-on.” Yet patients in rural areas who live “six or eight hours from an academic centre” face nearly impossible travel barriers for frequent trial visits.
Key barriers patients face:
- Geographic isolation requiring extensive travel
- Financial constraints limiting participation
- Limited awareness of trial opportunities
- Lack of guidance navigating the enrollment system
3. Biomarker and Genetic Testing Availability
How does personalized testing improve care? Biomarker and genetic testing can identify specific mutations in a patient’s cancer, allowing oncologists to prescribe targeted treatments tailored to that individual’s tumor. This precision medicine approach can significantly extend survival.
The access problem: Testing infrastructure exists primarily in larger provinces. Smaller provinces often struggle with limited availability or experience delays sending samples out of province for analysis—delays that can be critical when time matters for pancreatic cancer patients.
What you might not know: These tests can reveal inherited mutations that affect treatment options and family risk, yet many patients in smaller provinces never get the chance to access this information.
4. Shorter Wait Times for Diagnostics: When Every Week Counts
Why is diagnostic speed critical for pancreatic cancer? Early detection significantly improves survival chances. Delays in imaging diagnosis mean delayed treatment starts, and for pancreatic cancer, time is literally life.
The wait time gap: In 2024, Canadian patients face median wait times of 16.2 weeks for MRI scans and 8.1 weeks for CT scans. But these are national averages—rural and smaller province waits often stretch much longer. In some smaller provinces, waiting a few months for a scan is not uncommon, delaying critical diagnoses.
Questions patients ask:
- Why is my wait so long compared to someone in a big city?
- What can I do to speed up my imaging appointment?
- Are there faster options if I travel?
5. Access to Multidisciplinary Care Teams
What is multidisciplinary cancer care, and why does it matter? A multidisciplinary team includes oncologists, surgeons, dietitians, social workers, palliative care specialists, and nurse coordinators—all working together to address every aspect of a patient’s care. This integrated approach improves outcomes and quality of life.
The gap in smaller provinces: Patients might receive care from one overworked oncologist trying to manage everything alone. Without a coordinated team, patients miss out on:
- Nutritional guidance during chemotherapy
- Mental health and emotional support services
- Pain management strategies
- Practical support with treatment side effects
The patient impact: A patient in a large center with a full team experiences more comprehensive care, better symptom management, and improved overall wellbeing compared to someone managing cancer with limited support.
6. Availability of Second Opinions
Why would a patient seek a second opinion? For serious diagnoses like pancreatic cancer, a second opinion from another specialist can provide peace of mind, confirm treatment plans, or reveal alternative approaches.
The reality: In larger provinces, seeking a second opinion might be as simple as calling another hospital. In smaller provinces, it could require traveling to another province entirely—an expensive and time-consuming undertaking that many patients cannot afford.
7. Proximity to Advanced Treatments
What are the latest pancreatic cancer treatments? Advanced options like HIPEC (heated intraperitoneal chemotherapy) or precision radiation therapy represent cutting-edge approaches that can extend survival.
The access problem: These technologies are concentrated in major academic centers. Smaller provinces may not have the infrastructure, equipment, or trained personnel to offer these options, leaving patients with more limited treatment choices.
8. Support Groups and Resources
How do support groups help cancer patients? Support groups connect patients with others facing similar challenges, reducing isolation and providing practical advice. Advocacy organizations amplify patient voices and fight for better care standards.
The gap: Larger provinces have robust support networks and local advocacy organizations. Smaller provinces often have limited or non-existent local resources, leaving patients to rely on online forums or traveling for in-person support. Online communities and virtual peer support are lifelines for many.
9. Coverage for Medications and Travel Support
How do travel costs impact treatment? When patients must travel hours or travel out of province for treatment, the costs accumulate quickly: gas, accommodations, parking, meals, and time away from work.
Heather Cutler Foundation
Provincial program disparities: Some larger provinces offer medication coverage or travel reimbursement programs. Smaller provinces often lack similar support, leaving patients and families facing significant out-of-pocket costs.
10. Awareness and Advocacy Networks
Why does advocacy matter? Louder, organized voices influence healthcare policy, funding allocation, and service expansion.
The result: Larger provinces benefit from robust pancreatic cancer and broader cancer advocacy networks. Smaller provinces often get left out of the conversation entirely, leaving their patients feeling invisible and unsupported at a critical time.
Reflecting and Pushing for Better
This holiday season, let’s take a moment to appreciate the privileges we have if we live in a larger province—things like access to care close to home, specialists, and the latest treatments. But more importantly, let’s think about those who don’t have the same opportunities.
The people we should advocate for:
- Those driving hours just to get treatment
- Patients waiting months for diagnostic tests
- Individuals missing out on clinical trials that could save their lives
- Families choosing between treatment and financial survival
These inequities remind us why pushing for better pancreatic cancer care across Canada matters—not as a nice-to-have, but as a fundamental requirement of a fair healthcare system. As one patient caregiver reflected: “One of the most valuable things we can do to heal one another is listen to each other’s stories.”
How You Can Help: Concrete Actions
Whether you’re a patient advocate, healthcare professional, or concerned citizen:
- Advocate for improved diagnostic services in underserved provinces
- Push for equitable access to clinical trials through decentralized trial models
- Support travel subsidy programs for patients requiring out-of-province care
- Amplify the voices of rural and smaller-province patients in policy discussions
- Fund research into how to deliver specialized care remotely
- Champion telemedicine and remote monitoring for trial participation
The Bottom Line
Let’s appreciate what we have, but never stop fighting for what’s fair. Together, we can build a healthcare system where a pancreatic cancer diagnosis doesn’t come with a different prognosis based on your postal code.
