Nova Scotia

N.S. could save millions by expanding hematology department, says specialist

The interim head of Nova Scotia's hematology department says the province could save millions of dollars by adding more staffing and offering treatments that patients must currently be sent away for.

Patients being sent to Boston for costly procedure that could be done cheaper here, says Dr. Sudeep Shivakumar

Dr. Sudeep Shivakumar says the hematology department doesn't have the proper staffing to offer goundbreaking therapy to its patients. Instead, they're being sent to Boston at a huge cost to Nova Scotia taxpayers. (Patrick Callaghan/CBC)

The interim head of Nova Scotia's hematology department says the province could save millions of dollars by adding more staffing and offering treatments that patients must currently be sent away for.

Dr. Sudeep Shivakumar said in the past few years, there have been significant developments in the treatments of blood disorders and cancers. As a result, patients are living longer, but now there aren't enough specialists to treat them all.

Among those treatments is CAR-T therapy. The groundbreaking procedure takes T-cells out of a patient's body through their blood. The cells are then modified to attack cancer cells.

"The results have been nothing short of amazing," said Shivakumar. "Some blood cancers patients whose survival is previously measured in months, now the majority after CAR-T are living for two years."

Shivakumar said the department has the ability to do the treatment and wouldn't need additional equipment. Rather, it would require an increase in staffing levels.

The human T-cell, pictured here in a scanning electron micrograph, is key to CAR-T immunotherapy. (U.S. National Institute of Allergy and Infectious Diseases)

Patients approved for CAR-T therapy are being sent to the Dana-Farber Cancer Institute in Boston, with a price tag of about $1 million per patient.

Shivakumar said so far, Nova Scotia has approved nine patients to go.

"Doing it here ourselves, once we have the proper resources, would be a huge cost savings to the province, slicing off at least half of that cost," he said.

The likelihood of expanding treatment options has also been hampered by a shocking loss, the sudden death in March of Dr. Stephen Couban, who was the head of the hematology department.

"He cared for the patients of Nova Scotia and was a real fierce advocate for them, making sure that people in Cape Breton had the same access to care that people in other cities did, for example," said Shivakumar.

Couban worked in Nova Scotia for decades and was nationally known for his efforts in the field.


"Dr. Couban was irreplaceable," said Shivakumar. "He did the work of, I always say, two or three or four hematologists."

It's unknown how many patients Dr. Couban treated, but Shivakumar said the list is 40 to 50 pages long.

A new hematologist was hired in the beginning of November, but even with the vacancy filled, Shivakumar said they need more staff to manage the caseload.

Dr. Stephen Couban, seen in an interview with CBC in 2003, died unexpectedly in March. The hematology department is trying to prioritize his thousands of cases to make sure everyone is seen in a timely manner. (CBC)

"We were overcapacity even before his passing and now we're in an even more tight spot," said Shivakumar.

The Health Department said in a statement that it puts a high value on the hematology department's work.

"We understand the recent loss has placed a strain on resources," it said. "We would await a clinical decision and recommendation from NSHA on any new proposals."

Shivakumar said he's convinced that by hiring more specialists, nurses and other support staff, the province will save a significant amount of money by treating people in the province instead of sending them away.

"We do need more hemotologists urgently," he said. "As a centre of excellence, I think we should be doing that."


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