It’s an average day at Princess Margaret Hospital’s genitourinary clinic and Marcia MacLeod is hard at work handling the dozens of patients pouring through for their regular examinations.

The energetic registered nurse (R.N.) case manager works through her roster of appointments with military precision, greeting her patients as if they were long-lost friends, asking questions and discussing details of their treatment. This is MacLeod’s way of personalizing the service she gives as a front-line oncology nurse at one of North America’s foremost cancer hospitals.

“If I gave a patient the impression that I wasn’t interested in helping him or her through, I think they’d be very reluctant to call me,” she says.


R.N. case managers, as they’re known in Ontario — or cancer patient navigators as they’re referred to in provinces such as Nova Scotia and Alberta — are equal parts patient advocate, educator, coach and care co-ordinator, helping patients navigate health-care systems that can seem impossibly complex.

Sandra Cook, project manager for cancer patient navigation with Cancer Care Nova Scotia, says the cancer patient navigator designation was implemented in her province in 2001 at the request of patients, families and front-line staff who realized the need for more individual care.

“The cancer centres found that the patient who was navigated came prepared to make decisions, was able to understand their disease and their disease pathology,” Cook says.

Similar programs have been implemented or are being studied across Canada.

Donna Czukar, director of cancer information and support for the Ontario division of the Canadian Cancer Society, feels although there is still work to be done, personalized front-line cancer care is easing the burden on ill patients, their loved ones, and the health-care system.

“I think the good news is that it’s getting more attention and the services that are addressing these needs are getting more profile and will be addressed more,” she says.

Back at Princess Margaret, MacLeod acknowledges that despite the rigorous workload, she finds strength from her hundreds of patients.

“Knowing that you’re up against a potentially terminal illness, that takes great courage,” she says.

“(Seeing people do) it with humour, doing it with consideration for other patients, it feels like I come to church every day. I’m not a church-going person, but sometimes I say I don’t need to go to church because of what I see here.”