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The Globe and Mail

Ontario cancer patients denied coverage would get a chance under new program

A pharmacologist injects a phial of concentrated Herceptin in London June 9, 2006.

Luke MacGregor/Reuters/Luke MacGregor/Reuters

A provincial agency is proposing a new program so Ontario cancer patients – ineligible for crucial drugs due to strict treatment guidelines – have another shot at obtaining them.

Neala Barton, spokeswoman for Ontario Health Minister Deb Matthews, confirmed late Thursday that active discussions are taking place with Cancer Care Ontario, which co-ordinates the province's cancer services and prevention efforts.

Ontario would be hard-pressed to ignore the agency's recommendation to allow some patients, who fall outside treatment guidelines, to be evaluated on a case-by-case basis for cancer drugs. It gives the province a perfect out for the emotionally charged case of Jill Anzarut, 35, first detailed in The Globe and Mail last week. At .5 cm, her breast tumour was deemed too small to qualify her for Herceptin.

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"What this whole discussion about Herceptin coverage has pointed out in the last week and a half is that the system is really complex, and obviously it gives us an opportunity to make the system better and that's I think what we need to be thinking about here," said Carol Sawka, Cancer Care Ontario's vice-president of clinical programs and quality initiatives.

The proposal for a new mechanism comes as another Ontario woman, Irene Price, 52, said she was turned down after multiple tumours in her breast did not add up to drug coverage. But they were plentiful enough to warrant surgical removal of her entire left breast.

"I don't have $40,000," Ms. Price, who works for a catering company, said in a telephone interview from Kitchener. "It was quite devastating when you get the diagnosis. Whether it's big or small, it's still cancer."

Unequal access to Herceptin has been a contentious issue for breast cancer patients and a delicate issue for a government trying to provide the best care while maintaining a firm grip on health spending.

But the government's stance to deny the drug has been a difficult position to maintain, given that British Columbia, Alberta and Saskatchewan all fund Herceptin for smaller tumours, as do Quebec, Newfoundland and Manitoba on a case-by-case basis.

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 treatment guidelines.

The 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, which affects 20 to 25 per cent of breast cancer patients.

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Under the new proposal, patients could apply on a case-by-case basis for drugs for which they are ineligible, either because they fall outside of treatment guidelines or where no guidelines exist due to the rarity of a cancer, confirmed Cancer Care Ontario spokeswoman Elizabeth McCarthy. Currently, "we don't have any jurisdiction, any authority to fund any medications beyond what the criteria has set out," she said.

Dr. Sawka said she could not speculate on what a program might look like. "It's under discussion right now," she said. "Nobody's approved it, but everybody sees that is something that we don't have right now."

British Columbia has had such a system for years, said Marianne Taylor, medical director of BC Cancer Agency's compassionate access program. And it's a busy one, reviewing 4,858 requests for cancer drugs in fiscal 2009-2010, with most of those requests – 4,093 – being accepted, most within a day. A small number were rejected and others were considered conditional, which means more information was required.

"If you want to use a drug that isn't on one of those guidelines and the patient doesn't quite fit, then you put in a compassionate access request," Dr. Taylor said in a telephone interview from Kelowna.

Gerald Batist, director of the Segal Cancer Centre at Jewish General Hospital, said Quebec has treatment guidelines but there is flexibility to provide drugs on a case-by-case basis for patients such as Ms. Anzarut and Ms. Price, who are in a medical grey zone.

"Generally speaking, if it works in tumours that are 1 centimetre, why would it not work in tumours that are smaller," Dr. Batist asked in a telephone interview from Montreal. "The worst thing in the world for a patient is to feel that something out there can help her that she can't have access to. In this case, it may well help her."

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