The Time is Now to Rethink the War on Cancer
TORONTO, Feb. 12 /CNW/ - According to the Cancer Advocacy Coalition of
Canada (CACC), the current Canadian cancer system is based on outdated,
outmoded thinking past its "best before date." In its 10th Report Card on
Cancer in Canada(TM), the CACC reports Canadians are experiencing care that is
inconsistent, unfair and ineffective.
Gross discrepancies in access to the diagnostic tools and best treatment
for cancer exist, depending upon where a person lives in the country. "Tell me
your postal code, and I will tell you your chances of surviving cancer," says
Dr. William Hryniuk, past chair of CACC and former director of cancer centres
in the Canada and US.
The Report Card on Cancer in Canada is the country's only independent
evaluation of the cancer system performance. This year's Report Card
highlights the lack of funding for prevention research, the need to refine the
clinical trials system, the need to enhance the role of nursing in supportive
care, and the need for greater utilization of technological innovations in
cancer diagnosis and treatment.
According to the findings of the Report Card on Cancer in Canada,
Canadians must be alerted - they cannot rely on their public and existing
private insurance to assure them of access to their best chances of surviving
cancer. The CACC calls on the governments to take a leadership role in forming
a collaborative solution, involving all stakeholders, that ensures fair and
timely access to new cancer treatments for all Canadians regardless of where
in Canada a person lives.
"If we choose to, we can have the best cancer management system in the
world," said Dr. James Gowing, Chair, CACC.REPORT CARD HIGHLIGHTS
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1) Cancer Drug Costs: Who's Paying Now?
CACC researchers analyzed sources of payment - private vs. public - for a
select group of 23 cancer drugs, from 2002 to 2006,(1) with the following
results:
- As the 23 drugs became available commercially in Canada, private
payouts for the selected drugs increased steadily in each province
(Table 1).
- For the new generation of oral, take-home cancer drugs, the cost to
both public and private funders has increased rapidly.
- Seven oral, take-home cancer drugs account for the majority of
private claims and costs: Xeloda, Temodol, Gleevec, Tarceva and three
aromatase inhibitors: Femara, Aromasin and Arimidex. While the public
systems in some provinces continue to pay a higher proportion of
costs especially for these seven drugs, the proportion borne by the
private payer sector is steadily increasing.
- In Ontario and Quebec, the cost of drugs to the private sector is
doubling every two years, while the cost to the public sector is
doubling at a slower rate (2.5 to 3 years).
- In Ontario the cost of cancer drugs borne by the private sector
vs. the public sector has increased from 31 per cent in 2002 to
40 per cent in 2006.
- In Quebec, the cost of cancer drugs borne by the private sector
has increased from 28 per cent in 2002 to 39 per cent in 2006.
- B.C. in particular, and the western provinces in general, continue to
have the best access to publicly funded cancer drugs; private drug
costs are significantly lower in these provinces as publicly funded
budgets tend to cover many of the oral, take-home medications.
- In the Atlantic provinces, private payer expenditures exceed the
public provision for oral, take-home drugs.
- These data do not capture direct payment for cancer drugs by
patients. The volume and costs for that group of Canadians remain
unknown.
Table 1. Private pay for Cancer Drugs in Canadian Provinces for 2002-
2006, expressed per estimated incident cancer case in each year
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Private Drug Costs per Incident Cancer Case
------------------------------------------------------------------------
Province 2002 2003 2004 2005 2006
------------------------------------------------------------------------
BC $52.00 $39.61 $66.63 $129.75 $81.07
------------------------------------------------------------------------
AB $27.63 $23.15 $29.06 $58.85 $87.98
------------------------------------------------------------------------
SK $0.00 $0.00 $29.49 $15.18 $33.00
------------------------------------------------------------------------
MB $32.67 $35.36 $62.95 $111.05 $134.29
------------------------------------------------------------------------
ON $137.21 $206.66 $339.20 $425.82 $551.52
------------------------------------------------------------------------
QC $131.07 $241.91 $368.26 $460.21 $600.44
------------------------------------------------------------------------
NB $240.73 $355.03 $418.64 $560.56 $721.63
------------------------------------------------------------------------
NS $125.41 $140.66 $206.03 $363.91 $383.62
------------------------------------------------------------------------
PEI $93.73 $246.04 $323.37 $527.68 $684.40
------------------------------------------------------------------------
NL $171.59 $238.67 $386.83 $478.58 $456.46
------------------------------------------------------------------------
2) Cancer Drug Access and Public Funding Status
Access to new and expensive cancer drugs continues to be one of the most
urgent problems cancer patients face. CACC researchers conducted a
province-by-province review of access to 24 drugs featured in past reports,
adding an analysis of 18 new therapies representing a "fresh wave" of evolving
treatments (Table 2). The following trends were observed:
- Western provinces continue to lead the way in providing new cancer
drugs to their citizens.
- Ontario continues to fully fund the lowest number of the 42 drugs
studied.
Table 2. Summary of Cancer Drug Access and Public Funding Status
Comparing Past 24 Drugs Studied and 18 New Drug Indications (Status as of
Dec. 25, 2007)
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PAST 24 DRUG INDICATIONS 18 NEW DRUG INDICATIONS
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Recom- Recom- Not Ap-
Approved Limited mended Not Approved Limited mended proved
and Access/ but not Approved and Access/ but not or
Funded Funding Funded or Funded Funded Funding Funded Funded
-------------------------------------------------------------------------
BC 20 1 0 3 12 1 4 1
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AB 14 7 0 3 4 7 3 4
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SK 14 2 3 5 4 0 0 14
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MB 16 2 1 5 3 4 0 11
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ON 6 11 3 4 3 4 0 11
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QC 16 6 0 2 7 2 0 9
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NB 6 13 0 5 4 2 0 12
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PEI 14 1 0 9 3 0 0 15
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NS 7 9 0 8 4 2 4 8
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NL 8 11 0 5 3 2 0 13
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- People with less common cancers face increased difficulty accessing
life-extending drugs for which there is only a small market, and no
incentive for approval in Canada; this is evidenced by a marked delay
in approval times between Canada and the US for these types of drugs,
a reflection of several factors including Health Canada timelines for
review and whether or not the drug manufacturer has submitted an
application.
- Increasingly, one of the few ways to access new cancer drugs is via
the manufacturer's compassionate access or expanded access programs;
these may enable patients to access drugs that may not yet have
received Health Canada approval or provincial funding, however
criteria is strict.
3) Pet Scanning: Progress in Access, regional variations persist
CACC researchers documented access to PET scans across the country, with
the following observations:
- Gradually, the barriers for cancer patients being able to access PET
scanning for approved indications are being lowered across the
country.
- Albertans have ready access to a PET scan for any one of 15 types of
cancer and 24 indications. In contrast, access to PET scanning in
Ontario is limited to eight indications, and then only through a
formal clinical trial (three), or a special registry (five).
4) Research: Where do our research dollars go? Updating information from
the CACC report of 2004,
- Only 6% of all research dollars goes to cancer prevention.
- Canadian Institutes of Health Research: no change in funding
allocations. Still 70% basic research, much of which is not very
sharply focused on solving clinical problems.
- Ontario Institute for Cancer Research: basic research is sharply
focused on solving clinical problems in treatment.
- Canadian Cancer Society/National Cancer Institute of Canada: shift in
strategy away from basic research and towards more treatment and
prevention research.
- Conclusions: It is time to align research priorities with societal
priorities, not researchers' priorities.
- Oversight by a Federal all-party Parliamentary committee is required
to ensure cancer research is linked to cancer control.
5) Critique of the Breast Cancer Clinical Research Process: Could More
Lives be Saved?
CACC researcher Dr. Joseph Ragaz conducted a systemized review of
randomized clinical breast cancer trials since the early 1980s, and found a
system that is rapidly becoming obsolete. Key observations include:
- The present sequence of steps in testing new cancer drugs is based on
principles developed in the 1970s and 1980s and can't accommodate the
rapid emergence of new, possibly curative drugs.
- It currently takes a minimum of 10-15 years for a new agent to reach
the clinic from a laboratory bench, and in many cases up to 20 years
with repetitive clinical trials required. This timeline could be
shortened significantly (by at least five years), and thousands of
lives and millions of dollars saved, if key findings in late-stage
cancers were applied to early-stage cancers much sooner.
- Successful response in advanced disease is known to be a predictor of
sensitivity in earlier disease, yet there are significant delays in
applying this knowledge, and lives have been lost as a result.
6) Young Adults with Cancer - The Forgotten Generation?
Cancer patients between the age of 15-39 are experiencing inordinately
high mortality which is being ignored by the cancer system. This is due to:
- Inadequate research investment (tumours behave differently in this
age group)
- Inadequate supportive care for their unique psychosocial issues
7) The Role of the Nurse in Supportive Care
Nurses are key to helping patients navigate through their cancer care and
cope with the physical and emotional burdens cancer. CACC researchers
conducted a cross-Canada survey of oncology nurses to determine the extent of
supportive care the nurses were able to provide to patients. Key observations
include:
- Nurses are ideally suited to provide supportive care, however too
many nursing hours are lost to non-nursing duties (watering plants,
changing linens, etc). Nurses must be relieved of the many extraneous
tasks that abound in a clinic so their professional time is applied
to nursing patients.
- If nurses were able to practice to the full scope of their profession
they would be able to spend one day per week navigating patients
through the cancer system and attending to their supportive care
needs.
- Cancer centres should identify and remove attitudinal and
administrative barriers to a fully implemented Primary Nursing model
of care.ABOUT THE CACC
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The Cancer Advocacy Coalition of Canada is the country's only full-time,
registered, non-profit cancer group dedicated to citizen advocacy. The CACC is
not a charity and operates on un-restricted grants based on guidelines that
ensure the organization's autonomy. For more information visit our website at
www.canceradvocacy.ca
The full Report Card is available on-line at www.canceradvocacy.ca
For further information: NATIONAL Public Relations, Jacqueline
Zonneville or Tiffany Shiu, (416) 848-1398
