LEADING SCIENCE, LAGGING SYSTEMS
Among challenges facing cancer system: 1) restrictive HPV vaccine
programs among provinces with highest rates of cervical cancer;
2) little use of electronic health records in remote communities that
need them most; time to give cancer patients full access to their own
electronic health records; 3) an alarming shift in drug funding from
public to private payers; 4) catastrophic drug costs endured by cancer
TORONTO, Feb. 10 /CNW/ - Many Canadians living with cancer have yet to
benefit from important advances in drug development, information technology
and innovative insurance models, according to the Cancer Advocacy Coalition of
Canada (CACC). The group today released its annual Report Card on Cancer in
Canada, the country's only independent evaluation of the cancer system
This year's Report Card highlights several unsettling themes: under-use
of electronic health records linking distant communities to their regional
cancer centres, potentially robbing patients of opportunities for better
health outcomes; a disturbingly lower rate of the HPV vaccine program among
several provinces with the highest incidence of cervical cancer; the rapid
shift in drug funding from public to private payers; and catastrophic drug
costs for cancer patients.
"We have leading science and lagging systems. For example, if patients
can access their financial records from anywhere in the world, why not their
health records?" says Dr. William Hryniuk, medical oncologist and past-chair,
CACC . "If they could, their disease management would greatly improve and many
system changes would quickly follow."
Report Card Highlights
1) HPV VACCINATION PROGRAMS IN CANADA: ARE WE HITTING THE MARK?
CACC study reveals many of the most restrictive HPV vaccination programs
are in provinces with the highest rates of cervical cancer
The province of Quebec offers the most comprehensive immunization program
against human papillomavirus (HPV), with 100 per cent of eligible females
included, while Manitoba, Nova Scotia, Prince Edward Island, Saskatchewan,
Yukon Territory, New Brunswick and Alberta have very restrictive programs,
with less than 55 per cent of eligible females included. Ironically, Nova
Scotia, PEI and Alberta have the highest rates of cervical cancer in Canada,
and Quebec the lowest rate.(1)
"Our research reveals that the vaccination programs bear absolutely no
relationship to the risk of cervical cancer in each province," says Rosemary
Colucci, lead author of the study. "Sadly, the differences in provincial
programs may eventually result in differences in effective control of cervical
In 2007 the federal government allocated $300 million over three years to
the provinces and territories on a per capita basis to support the launch of a
national vaccination program against human papillomavirus (HPV), the cause of
cervical cancer. All of the provinces and the Yukon Territory responded by
introducing vaccination programs targeting various cohorts of females between
the ages of 9 and 17.
2) COMMUNITY ONCOLOGY AND ELECTRONIC HEALTH RECORDS: WHAT GIVES?
CACC research reveals little or no use of electronic health records in
remote communities that need them the most
Cancer patients should be given immediate and continuing access to their
health record to ensure optimal care, especially if they live a distance from
a regional cancer centre. Yet according to a CACC survey of oncology clinics
located more than two hours from a regional cancer centre, most aren't using
electronic health records to record vital information.
Of 11 clinics surveyed across the country, only seven had access to an
integrated EHR system linking them to the tertiary centre; and of these seven,
only three allowed clinicians to enter data.
"The net result in these cases is that tertiary centre oncologists who
originally devised the treatment plans were not able to follow whether
treatment was being given, or what complications were encountered," says Dr.
William Hryniuk, past chair of CACC and lead author of the study. "This raises
the possibility that patients in these communities may not be getting the full
benefits of care in terms of efficacy, safety, and efficiencies received by
patients in direct proximity to regional cancer centres."
Management of cancer requires, in virtually every case, multidisciplinary
treatment delivered by a large number of health care personnel located in
different locations, says Dr. Hryniuk. "Use of an EHR would seem to be unique
and appropriate for optimizing treatment and care. It might even be viewed as
a critical component of any provincial or regional program when toxic
chemotherapy prescribed by specialists at the tertiary care centre must be
delivered in distant communities by non-specialists."
Based on the survey, the potential of electronic health records to
improve patient outcomes is not being realized even where systems are now in
place. The CACC recommends giving patients access to their own electronic
health records, as the Edmund Odette Regional Cancer Centre at the Sunnybrook
Health Sciences Centre in Toronto does, to empower patients and help overcome
institutional barriers to optimum use of the technology.
3) SEISMIC SHIFT IN CANCER DRUG FUNDING TO PRIVATE PAYERS
CACC study reveals steady shifting of drug costs from public to private
insurers; millions of Canadians to be left without access to newest
therapies and insurance coverage.
Canadians without full-time jobs or health insurance plans take note: a
new study reveals that funding for oral take-at-home cancer drugs is being
shifted from public to private insurers at a rapid rate, leaving employers and
individuals to shoulder the increasing burden of cost. And, with the number of
cancer patients expected to grow by 55 per cent by 2020, aging baby boomers
and part-time workers may be most at risk of not accessing the newest
"Expenditures for oral, take-at-home therapies now represent
approximately half of the total for all cancer drugs," says Dr. Kong Khoo, a
B.C. medical oncologist and lead author of the study. "Employers and insurers
should be made aware of the magnitude and pace of these shifts."
For the study, CACC researchers reviewed oral, take-at-home cancer drug
expenditures in each province, for the years 2002-2007, using data from Brogan
Inc. and the provinces. Cancer drugs studied included oral chemotherapy
agents, hormonal therapies, tyrosine kinase inhibitors (new "targeted"
therapies) and supportive medications used to treat the symptoms of cancer
(antiemetics, bisphosphonates, hemotopietic stimulating factors). Key findings
include the following:
- In the western provinces the proportion paid for take-at-home cancer
drugs by the public system is much higher than by private insurers.
This proportion decreases east of the Manitoba border and is reversed
in the Maritimes
- While both public and private payer expenditures for take-at-home
cancer drugs are increasing, private payer expenditures are
increasing at a much faster rate across all provinces
- The shift of funding to the private sector is steadily increasing the
burden on employers and individuals who are ill prepared to deal with
- A small number of newer agents (10 of 43 studied) accounts for more
than 80 per cent of the total expenditure on all take-at-home drugs
- Apart from Quebec, where supplementary drug insurance is mandatory,
private and public insurers in the other provinces have yet to come
to grips with what is happening and coordinate their drug coverage
4) A PRIMER ON PRIVATE HEALTH BENEFIT PLANS
CACC study reveals need for integrated and universal public-private drug
insurance to protect Canadians from catastrophic drug costs.
Private insurance plays a critically important role in assuring access to
medically necessary prescription drugs. Like their government plan
counterparts, employers face many cost pressures, but unlike public plans,
there is no requirement to provide these benefits.
"Costs have escalated at about 400 per cent of the Consumer Price Index
over the last 22 years," says Chris Bonnett, president, H3
Consulting/businesshealth. "Particularly in this economic climate, relatively
open access and willingness to continue to fund their $9 billion stake will be
Private health plans provide incredibly important peace-of-mind to over
20 million employees and their families; a recent survey reported that 61 per
cent would rather have their health benefit plan than $20,000 cash.
Largely a silent partner over the last 40 years, the scale and importance
of these plans now makes them an important part of our national health policy
deliberations. Oncology drugs are usually made available much sooner under
private plans than government plans, and most new products are tablets, and
therefore they do not have to be administered in hospital and funded by the
public purse. While cancer most often occurs in older Canadians, almost 30 per
cent (48,000 people) are diagnosed annually in the working age population,
those 18 to 60 years old. Most private plans terminate at retirement, leaving
those most at risk unprotected from significant financial cost.
Health benefit plans are funded most often by employers, but almost
always, employees have a significant cost-sharing role. For smaller plans, the
insurer takes the full risk, but larger employers (over 100 employees)
typically self-insure their drug plans, and therefore have the final say on
what and who is covered, and what coverage exclusions exist.
The bigger issue, however, is that a reasonable 20 per cent co-pay on a
$60 average drug becomes unaffordable when the drug costs $25,000 or more.
This is a major policy void that that neither the insurance industry nor our
governments have yet solved, despite significant study over the last decade
and a generally successful working model in Quebec. Pooling high cost drug
claims, often catastrophic to patients and their families, is an idea whose
time is long overdue.
About the CACC
The Cancer Advocacy Coalition of Canada is a 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
The full Report Card is available on-line at www.canceradvocacy.ca
(1) Canadian Cancer Society, Canadian Cancer Statistics, 2008
For further information:
For further information: NATIONAL Public Relations, Jacqueline
Zonneville, (416) 848-1398, firstname.lastname@example.org; Pamela Arora, (416)