Family wonders if a quicker cancer diagnosis could have saved Thunder Bay, Ont., woman's life

A nurse in Thunder Bay, Ont., is seeking answers about why her mother — who died last year — couldn't get an appointment with a blood-disease specialist until she received a cancer diagnosis, and is pushing for changes that would let some patients see one sooner. 

Heidi Smith died in August 2022 at age 63 of Stage 4 peripheral T-cell lymphoma, a rare form of blood cancer, said her daughter, Mariah Mrakic-TenHave.

Smith, who was already a breast cancer survivor, received a number of diagnostic tests over 15 months at the Thunder Bay Regional Health Sciences Centre (TBRHSC). They included blood tests, MRIs, needle nose aspirations and other biopsies — but the results kept coming back inconclusive. 

Despite her declining health, Smith was not allowed to see a hematologist in Thunder Bay without a cancer diagnosis.

"While this was going on, her body couldn't take it anymore," said Mrakic-TenHave. "At what point do we say, 'This is enough? We've done all the tests we can and our patient is not getting any better.'"

CBC News interviewed Mrakic-TenHave at both her childhood home, where she moved after her mother died, and the family's property at an RV Park just outside the city.

Mrakic-TenHave said her mother underwent testing for more than a year in Thunder Bay. After that, Mrakic-TenHave contacted a surgeon in Toronto who had previously treated her mother's breast cancer 10 years before. Three weeks later, Smith had a sixth biopsy, which finally resulted in a cancer diagnosis, followed by chemotherapy in Toronto over the next five months.

She returned to Thunder Bay to complete her treatment closer to home, but died during a COVID-19 outbreak at the hospital. Her autopsy lists the cause of death as refractory lymphoma — meaning the lymphoma did not properly respond to treatment.

Mrakic-TenHave wants to see the Thunder Bay hospital change its policy related to specialist referrals in two key ways:

"They say an early diagnosis is key for fighting cancer or fighting any illness," Mrakic-TenHave said. "There needs to be a limit. You can't just keep testing somebody. My mom told me at the end, she didn't feel human anymore."

TBRHSC's communications department said the hospital could not facilitate an interview or comment on a specific patient's case. Instead, they provided written statements to CBC News.

"Regional Cancer Care Northwest at Thunder Bay Regional Health Sciences Centre follows the standards of practice that are part of all cancer programs in the province. As such, a diagnosis of hematological malignancy is established prior to being scheduled with a hematologist for treatment planning," said TBRHSC spokesperson Marcello Bernardo in an email.

A spokesperson for Ontario's Ministry of Health, Bill Campbell, told CBC News in an email that "protocols for referrals to specialists are determined at the local level."

There are two malignant hematologists at the TBRHSC. Both specialists are tasked with treating cancers, not diagnosing them.