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Health minister reaches out to cancer patient refused Herceptin

Breast-cancer patient Jill Anzarut at Toronto's Princess Margaret Hospital.

Fred Lum/The Globe and Mail

They spoke woman to woman, but the talk between Ontario's Health Minister and a breast-cancer patient could not have been more loaded: One has the power to change the other's life.

Jill Anzarut, 35, has been pushing for a drug the provincial cancer agency will not provide - Herceptin - because her tumour at .5 cm was deemed too small.

Her emotionally charged case has breast-cancer activists enraged that a disease caught early is not eligible for the drug. Policy experts say there is only so much money and Health Minister Deb Matthews has been put on the defensive.

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What does a Health Minister do, when a cancer patient's case has gone viral in less than two weeks? In this case, she picked up the telephone.

"She said she was calling to see how I was feeling," Ms. Anzarut said. "We talked a little bit about how I was coping with the chemo. She said she was working hard to improve the situation and support for cancer."

Late this week, there were two developments: A provincial cancer agency proposed to government that patients who fall outside treatment guidelines be evaluated on a case by case basis; and Ontario's Ombudsman launched an investigation into whether the government's decision to restrict the drug from such patients was informed and reasonable.

Ms. Matthews, known for her ability to be tough in political and health-care circles, signalled changes may be coming. Ontario, she said, has an excellent cancer system, but there are grey areas where patients don't necessarily fit into the treatment guidelines, which is why she has asked her ministry and the cancer agency to explore other options.

"I think we owe it to the patients to really explore the options that might be available to help those patients who have a condition that falls into that grey zone," Ms. Matthews told reporters. "I absolutely understand when someone is faced with a diagnosis of cancer, they want to do everything they can to get better."

Ms. Anzarut's case has highlighted a gap in Ontario's cancer system: There is no mechanism for patients to obtain a drug of potential benefit if they don't fit treatment guidelines.

The drug is available for smaller-tumour patients in British Columbia, Alberta and Saskatchewan and on a case-by-case basis in Newfoundland, Quebec and Manitoba.

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Stephen Chia, chair of the British Columbia breast tumour group, said it's not that Herceptin is ineffective in smaller-tumour patients; it's that patients with smaller tumours are often not included in the clinical trials. Consequently, there are limited data on them.

"Cancer risk is not driven by how big a cancer is; it's not the size that drives it," Dr. Chia, a medical oncologist, said in a telephone interview from Vancouver.

HER-2 positive cancers, he said, tend to be more aggressive and more likely to recur. He said a cost-effectiveness study, due to be published, shows a year of Herceptin, at $40,000, is very cost-effective in terms of preventing cancer recurrences and other savings.

The costly drug has turned one of the most lethal forms of breast cancer into one of the most curable. When given with chemotherapy, it halves rates of recurrence within four years of diagnosis in patients with HER-2 cancer, about 20 to 25 per cent of breast-cancer patients.

An estimated 100 Ontario women each year are ineligible to obtain Herceptin as their tumours are too small - they must be greater than 1 cm - to qualify under current guidelines.

And that is why Ms. Anzarut is pressing so hard: Her life and those of other women could be on the line.

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"I'm not suggesting opening the flood gates at all," Ms. Anzarut said. "But I do think the threshold [who is eligible for the drug]needs to make sense. Let's consider people who don't fit these criteria."

All eyes are now on Ms. Matthews who, despite a politician's breakneck schedule, found time Friday morning to make the call.

"The minister wanted Jill to know that she cares about what Jill and her family are going through," said Ms. Matthews's spokeswoman, Neala Barton, of the call. "It was a chance to touch base and speak to her as one woman to another."

That made Friday a good day for Ms. Anzarut. She's been having a lot of bad days since her cancer diagnosis a week before Christmas.

"I was appreciative of the phone call, for her to personally reach out," she said. "It was nice to connect."

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