In the first comprehensive and systematic study of Canadian medical oncologists' access to unfunded IV (intravenous) cancer drugs for patients with metastatic disease, Sunnybrook researchers quantitatively show half nationally have access in their own hospitals with a patchwork of access provincially – for example, from 92 to 12 per cent from one province to another.
The study, published in the Journal of Oncology Practice, also reports medical oncologists feel strongly that all means of access to unfunded drugs should be available, and do use these methods despite varying comfort levels on the means of access especially via non government- funded private infusion clinics in Canada or the United States.
New drugs offer modest improvements on outcomes for patients, but at significantly higher costs. The complexities of the issue make for difficult discussions in Canada's publically funded health care system. The Pan-Canadian Oncology Drug Review started reviewing drugs in October 2011 with the hope to improve consistency in cancer drug funding in Canada.
“Our study confirms that your ability to access needed cancer drugs varies substantially across the country,” says Dr. Scott Berry, a medical oncologist with the Gastrointestinal, and Genitourinary Cancer Care teams at Sunnybrook’s Odette Cancer Centre, and the study’s principal investigator.
"We recognize there are difficult choices on which new drugs to fund given the system's resource limits, but there needs to be more dialogue among policymakers about how to improve consistency of access across the country," says Dr. Berry, also an Assistant Professor of Medicine and the Director of the Medical Oncology Training Program at the University of Toronto.
The study surveyed all 222 Canadian medical oncologists outside of Quebéc, with a response rate of 62 per cent. Findings show half of medical oncologists nationally have access to unfunded cancer drugs for patients at their own hospitals (49 per cent via patients paying out of pocket, and 51 per cent via patients' private insurance). About two thirds have access via non government- funded private infusion clinics or clinics in the United States (70 per cent via patients paying out of pocket at a private clinic, 68 per cent via private insurance at a private clinic, 67 per cent via clinics in the U.S.).
Provincially, rates of access vary substantially: Alberta had a much higher rate of access to unfunded IV drugs in their oncologists' own hospitals at 92 per cent compared to 12 per cent in British Columbia. Oncologists' rate of access in Ontario in their own institutions was 49 per cent.
The researchers assessed medical oncologists' access to "effective" IV drugs – defined as "a drug shown to have a clinically significant improvement in survival for the treatment of metastatic cancer in larger randomized phase III trials and has been recommended for use by a respected provincial evidence-based guideline group."
In the study, the means/where of access to unfunded cancer drugs is defined as: at the medical oncologists' own government-funded hospital, at a non government-funded private infusion clinics in Canada or in the U.S. The how of access is defined as coverage using patients' private insurance, or by patients paying out of pocket.