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Ontario asks agency to review breast-cancer treatment guidelines

Dan Anzarut, right, sits near his wife Jill who will be undergoing the start of her chemotherapy program at Princess margaret Hospital on March 9, 2011. She's unable to receive the cancer-fighting drug Herceptin because her tumour is too small. She will have to pay for it out of her own pocket but she plans to fight this.

Fred Lum/The Globe and Mail/Fred Lum/The Globe and Mail

The Ontario government has asked the province's cancer agency to examine its five-year-old breast-cancer treatment guidelines after a woman's tumour was deemed too small to qualify her for a potentially life-saving drug.

Diane McArthur, executive officer of the Ontario Public Drug Programs, said she could not speak about Jill Anzarut, but she has asked Cancer Care Ontario to examine whether there is any new medical evidence that warrants a guideline change on Herceptin.

"We're constantly scanning to see if there is evidence that should adjust the guidelines," Ms. McArthur said on Wednesday in a telephone interview from Ottawa. The guidelines have not been changed since they were created in May, 2006.

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Ms. Anzarut, a 35-year-old mother of two, thought she was doing everything right when she caught her cancer early, but she was stunned to learn that at 0.5 cm, the tumour was too small to qualify her to receive Herceptin, which costs about $40,000 for a course of treatment. An estimated 100 women in Ontario each year will find themselves in the same position.

The drug, when given with chemotherapy, halves rates of recurrence within four years of diagnosis in patients with HER-2 cancer, a particularly aggressive form of the disease that affects 20 to 25 per cent of patients.

At issue is the unequal drug access breast cancer patients face across Canada: British Columbia, Alberta, Saskatchewan and Quebec all cover the drug for smaller tumours, while Manitoba and Newfoundland cover it on a case-by-case basis.

"There's a countdown for me," said Ms. Anzarut on Wednesday, hours after receiving her first round of chemotherapy at Princess Margaret Hospital. "The reality of what I'm going through really hit me today."

Whether Ms. Anzarut is able to obtain the drug rests solely with Ms. McArthur, who will rule on an exceptional access request made by Philippe Bedard, an oncologist at Princess Margaret Hospital.

Ms. McArthur has a 12-member committee of doctors, pharmaceutical experts, health economists and members of the public to consult, and many requests are granted. Specifically, 100,985 of the 163,072 requests were accepted in 2009-2010, translating into a 62 per cent approval, according to Ontario Health Ministry spokesman David Jensen.

As for Cancer Care Ontario, its spokeswoman Elizabeth McCarthy confirmed that it was asked to revisit the guidelines, stressing that even though they were created in 2006, they have been continuously reviewed over the years.

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What is clear is that the case of Ms. Anzarut is not going away. For the second day, Ontario Health Minister Deb Matthews, renowned in political and health-care circles for her ability to be tough, found herself surrounded by reporters on Wednesday.

She reiterated that she is unable to intervene, adding that: "I don't have the expertise. Nobody sitting around the cabinet table has the expertise to make these determinations.

"We can't make decisions about what drugs to fund based on what stories are on the front page of the newspaper."

The reality, said Ms. Matthews, is that there are limits to what the province can afford, adding that: "My heart goes out to people who are facing health challenges, who are desperate for any help, but I must rely on the experts."

Her critics, however, said she is simply trying to dodge the issue.

"What they need to review is the fact that this woman is in a terrifying situation and she needs her government to have compassion for her situation," said New Democrat Leader Andrea Horwath.

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And Progressive Conservative health critic Christine Elliott accused Ms. Matthews of abdicating her responsibility, saying it's going to cost the health-care system more money later if Ms. Anzarut does not get the treatment she needs now.

"This is very serious for her," said Ms. Elliott. "It's probably every woman's worst nightmare. I think that we absolutely owe it to her to further those inquiries."

Federal Liberal health critic Ujjal Dosanjh also weighed in, saying the federal government doesn't believe it has a role in health care, which is why the country has unequal access to medicines such as Herceptin.

"We should have national standards in health care. That's why we have problems like this," said Mr. Dosanjh. "We need a commitment to national standards, a national pharmaceutical strategy, building up to a national pharmacare program. The federal government has a large responsibility that they are shirking."

As for Mr. Anzarut, she is faced with the sad practicalities of many breast-cancer patients. She has tried on her wig and is preparing to tell her children Benjamin, 4, and Laila, 2, about her disease.

"I will tell them that mommy's medicine makes her feel better but it may make her tired and it may change her hair," said Ms. Anzarut. "I worry about telling my kids."

Who's who in the Ontario public drug programs

Ontario's drug czar:

Diane McArthur, an assistant deputy minister, was appointed executive officer of Ontario Public Drug Programs last spring after the departure of her predecessor, Helen Stevenson.


The year the post was created as part of a broader package of reforms aimed at reining in health-care spending.


Sole authority to approve drug recommendations from an advisory group of experts. Previously, such decisions needed cabinet approval.

The rationale:

To take the decision on which drugs get funded out of the hands of elected officials, Health Minister Deb Matthews says. A source familiar with the strategy said the government was unhappy with patients launching high-profile media campaigns to get their treatment funded. The new system, he said, gives the government a chance to distance itself from the decision-making process.


What the government spends a year on the drug programs.

Karen Howlett

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About the Author

Karen Howlett is a national reporter based in Toronto. She returned to the newsroom in 2013 after covering Ontario politics at The Globe’s Queen’s Park bureau for seven years. Prior to that, she worked in the paper’s Vancouver bureau and in The Report on Business, where she covered a variety of beats, including financial services and securities regulation. More

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