A woman whose breast cancer tumour was deemed too small for her to qualify for a potentially life-saving drug has been rejected for a second time.
Jill Anzarut, 35, made a last-ditch attempt to obtain the drug Herceptin through Ontario's exceptional access program. She found out from her oncologist on Thursday that her request was turned down.
"I feel defeated. I don't know what I expected to happen," said Ms. Anzarut, who is undergoing treatment at Princess Margaret Hospital in Toronto. "I feel like I am fighting a constant uphill battle."
Ms. Anzarut has used social media to draw attention to her plight and to press the Ontario government to make her eligible for Herceptin, which costs about $40,000 for a one-year course of treatment.
But Ontario's Health Minister made it clear on Thursday that she will not allow patients with well-orchestrated media campaigns to determine what drugs the province funds.
"We cannot have a health system where the stories that land on the front page of the paper determine our health-care policy," Deb Matthews said at the provincial legislature, where she came under fire from opposition members for the third consecutive day. "It would be unfair to those who do not get their stories on the front page if we were to give priority to those who do."
Ms. Matthews said the province does not have the financial resources to pay for every drug doctors recommend. But what makes Ms. Anzarut's case stand out, medical experts say, is the fact that Ontario's guidelines for breast-cancer treatment are outdated and out of step with those of many other provinces, which cover the drug for smaller tumours.
"You don't want to give a drug that has side effects and is very expensive to a patient who doesn't really need it," said Ellen Warner, an oncologist at Sunnybrook Health Sciences Centre and director of the hospital's PYNK breast cancer program for young women. "But I think there's enough evidence that at least a portion of these tumours are going to relapse and it's not a trivial portion."
Mr. Anzarut joined the Twitterverse last Saturday to tell her story after learning that her tumour, at 0.5 centimetres, was too small under the guidelines for her to qualify to receive Herceptin. "About to embark on the journey that is twitter … wish me luck!" she tweeted.
Her case has attracted widespread media coverage after appearing in The Globe and Mail, and has prompted the Ontario government to ask the province's cancer agency to examine its five-year-old breast-cancer treatment guidelines.
Diane McArthur, who decides what treatments the province funds as executive officer of the Ontario Public Drug Programs, has asked Cancer Care Ontario to examine whether there is any new medical evidence that warrants a guideline change on Herceptin.
"Everybody's talking about new evidence, but as yet, I have not seen any come forward," she said in an interview.
As things stand, the only other option is for women to pay for Herceptin themselves or through private insurance. Claudia Grieco was diagnosed with aggressive breast cancer in July, 2009, when she was 24. But she was not eligible for Herceptin because her tumour was 0.8 centimetres - just shy of the one-centimetre minimum.
"It was a slap in the face," she said in an interview. "It was almost as bad as finding out that I had cancer."
The news turned her life upside down, she said.
"My father was absolutely livid … he was just coping with my mother's death four years ago from cancer and then to hear that I might not get the treatment I needed was almost too much," she said.
But Ms. Grieco was one of the fortunate ones who got coverage for Herceptin through her work. She responded well to the treatment and has been cancer-free for almost a year. She has signed a petition imploring Ms. Matthews to change Ontario's policy on Herceptin.
Ms. Matthews said the experts, not politicians, decide what drugs the province covers. New Democrat Leader Andrea Horwath accused her of "throwing a rule book out there to hide behind."