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The question
I was recently diagnosed with metastatic breast cancer (it has spread to my brain, liver and bone) and my doctor told me if I do not get a drug called Tykerb, I may not see Christmas. The drug is not funded in British Columbia. It costs about $3,600 a month. Tykerb is, however, funded in other provinces. Why can someone living in Nova Scotia who has metastatic breast cancer get coverage for this drug but I can't?
The answer
Your predicament is unfair: A cancer patient in British Columbia should be able to access the same treatment as a patient in Nova Scotia.
Tykerb, also known by the generic name lapatinib, is a tablet publicly funded in Saskatchewan, Nova Scotia and Alberta, and on a case-by-case basis in Quebec. If you live outside those provinces, despite having the identical diagnosis, you are faced with paying for the medicine or not receiving it at all unless you have private insurance, which often covers it.
The drug is used for patients diagnosed with HER2-positive breast cancer whose disease has progressed while on treatment, said Karen Gelmon, a Vancouver-based medical oncologist.
"I hate to hear when cancer patients are paying for drugs," she said in a telephone interview. "That is not to say that every drug should be funded. But if there is good evidence for using a drug in a specific situation, I believe that it should be available in a publicly funded health care system. "
As Dr. Gelmon points out, it may not be the only drug for you. She wondered if you may be eligible to try another round of Herceptin or the chemotherapy drug adriamycin or hormone therapy. You may want to enlist in a clinical trial for a new medication.
It may be that you have tried some or all of these, and that your oncologist has found one drug that works for you, which is the one you are on now. It's possible to get a price break through the drug company's Patient Assistance Program; it provides discounts of up to 20 per cent depending on financial circumstances.
According to Dr. Gelmon, the initial study of Tykerb in recurrent HER2-positive breast cancer provided an improvement in overall survival of about 10 weeks for the group who received chemotherapy and Tykerb compared with the group who received only single-agent chemotherapy.
Unequal access to cancer drugs is a contentious issue in Canadian health care. Since health care is a provincial responsibility, every province has its own method of evaluating drugs. All of them say they look at the best scientific evidence and yet they come to different conclusions. I agree, it makes no sense that a drug deemed worthy of funding in one province is not covered in another.
In your case, a decision may be coming soon. The BC Cancer Agency's priorities and evaluation committee currently has the drug under review. I hope, for your sake, the news is favourable.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.