Ex-farmer Marvin Rempel remembers 1999 when his back was so sore he couldn’t walk.
The Swift Current, Sask., acreage dweller fell that summer and broke his back. An eight hour surgery followed a couple of months later.
“My bones were weak, I guess.”
The diagnosis was cancer, multiple myeloma. His doctors suggested he go for a stem cell transplant, using cells culled from his blood stream.
“I had never heard of it and wasn’t sure I wanted to do it. Then I talked to someone who had done it.”
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Stem cells are a primitive type of cell that are the precursors of other, more specialized ones in the body. There is one stem cell for every 100,000 blood cells. Stem cells are found in bone marrow where the body’s blood cells are made and they circulate in the blood stream.
For Rempel, the transplant involved replacing diseased cancer-ridden cells by first using radiation and chemotherapy to kill the faulty cells and make room for new healthy ones. Then when the cancer count in his blood dropped from 95 percent to five percent, the stem cells were collected from his body and injected back in to prime the pump to produce new cells.
It was a long process for Rempel, involving more than a year of preparation.
He had his stem cell transplant in Saskatoon in April 2001 and was sent home after two weeks to recuperate and be among germs that his body was familiar with. It was safer at home because he had no immune system and was weak.
He said it took him a year to feel good but today the 70 year old can work with his son on the farm, go fishing or do whatever he wants.
Rempel has regular checkups because he is not cured of cancer; it is in remission. He has a batch of his stem cells frozen because, as his doctor told him, “it’s not whether you will need another transplant but when.”
Rempel appreciates the transplant process he went through but is concerned because one of the three doctors doing the work in Saskatchewan will leave by the end of this summer.
He worries people will die because the waiting list of patients will grow with only two doctors doing the process.
Some other transplant patients have formed a group to ensure the program can handle the load.
Margaret Tompson of STEM, the Saskatchewan Stem Cell Transplant advocacy group, said Canada trains only one or two specialists in this area each year, so it is not easy to replace a hematology doctor.
She also noted the program is following almost 1,000 patients in Saskatchewan including the ones in transplant, plus before and after checkups.
The STEM group said that Manitoba, with a similar population, provides more funding for its stem cell transplant program and has double the number of hematologists as Saskatchewan.
Two of the group’s concerns are that the Saskatchewan government is reviewing the provincial cancer agency and that Health Canada will soon be doing an accreditation review of the stem cell program.
Former patients also say there are financial implications.
“We did a lot of travelling from Swift Current to Saskatoon, sometimes a couple of times a month. We were lucky we have a son living in Saskatoon and a son at home looking after the business. The wife drove the car. We had things pretty well covered. I feel sorry for people who have to leave the province or quit their job (to get treatment).”
Tompson said the stem cell transplant program budget in Saskatchewan is about $4 million a year. Last year, it transplanted 47 patients and sent 17 out of province. But if they all had to be sent to another province, it would have eaten up the whole budget.
She said if they had to be sent to the United States for treatment, then the budget would be gone after eight patients.
Bob Allen, the head of the Saskatchewan Cancer Agency, confirmed that the stem cell program will continue and that recruitment is under way to replace the third doctor. He noted that the program was started in 1997-98 by three partners – the provincial cancer agency, the provincial health department and the Saskatoon Health Region – and they are committed to it.
He also said a review of the program will start by September and be completed by November. It will be done using experts from outside the province.
“We all want a stable, quality program and that’s why the commitment to the review. … If the review finds gaps, we hope we can work with Saskatchewan Health in adequately resourcing the program.”
The director of the stem cell and hematology program, Dr. Michael Voralia, was less sure of the partners’ commitment. He said doctor retention is difficult not only because of the growing workload but also because of underfunding.
He said the program has been limited to 48 transplants a year, although there is a need to do about 70 patients a year. The program also treats about another 200 patients a year for blood diseases, not just stem cell transplants.
Voralia said the program’s budget last year was $3.3 million, which pays for patients’ tests and drugs as well as the doctors and other staff wages.
He noted that Saskatchewan recently agreed to spend the same amount to fund Herceptin, a drug that prevents breast cancer reoccurrence and is expected to save 12 lives a year.
