Ontario's Health Minister rejected calls to help a young mother obtain a costly breast cancer drug, saying she would be abusing her position if she got involved.
"It would be inappropriate, and probably illegal, for me actually to abuse my position to fight for drugs to be covered," Deb Matthews told reporters Tuesday.
She was commenting on the case of Jill Anzarut, a 35-year-old mother of two young children, who was told she is ineligible to receive the drug Herceptin, which costs about $40,000, because her tumour, at 0.5 centimetres, was deemed too small.
That Ontario medical guideline is in contrast to British Columbia, Alberta and Saskatchewan, all of which cover the drug for smaller tumours; Manitoba covers it on a case-by-case basis.
Ms. Matthews said the issue is best left to experts, adding: "I am not an expert and I cannot have opinions. I have to rely on the opinions of the experts."
One of those experts is Carol Sawka, vice-president of clinical programs and quality initiatives for Cancer Care Ontario. She said the agency's guidelines - to provide Herceptin to patients whose tumours are larger than 1 cm - are based on high-quality scientific evidence and there is no discretion to go outside of them.
Consequently, Ms. Anzarut's medical oncologist, Philippe Bedard of Toronto's Princess Margaret Hospital, made an exceptional access request to the province over the weekend to obtain the drug for his patient. He estimates 100 Ontario women each year will be in the same situation.
The exceptional access program is a patient safety valve, with a 12-member committee of doctors, pharmaceutical experts, health economists and members of the public making a decision, in some cases in as little as 72 hours, said Ontario Health Ministry spokesman Andrew Morrison.
The decision maker in that case - Diane McArthur, executive officer of the Ontario Public Drug Programs - was chairing a conference in Ottawa on Tuesday and could not be reached for comment.
Sandy Sehdev, a board director of the Cancer Advocacy Coalition of Canada, said there is a consensus among oncologists that the drug should be used in patients with smaller tumours.
"She [Ms. Anzarut]should take comfort the tumour was caught early," said Dr. Sehdev, a medical oncologist based in Brampton. "But she might feel had it been a pinhead larger, she might have qualified for it [Herceptin]"
Dr. Sehdev has seen patients in similar circumstances, with many having no private insurance to cover the costly drug and therefore having to forgo that part of the recommended treatment.
"Some probably would relapse who might not have," Dr. Sehdev said. "… Patients are very aware of these things and it causes a lot of anxiety if it can't be funded. As oncologists, we like to give the care that we would give to our own family."
Herceptin, when used with chemotherapy, has been found to halve rates of recurrences within four years of diagnosis for women who have HER-2 (human epidermal growth factor receptor type 2) breast cancer, which affects 20 to 25 per cent of patients.
Ontario's NDP Leader Andrea Horwath said the minister needs to show compassion by doing everything she can to make the drug available to Ms. Anzarut.
"If this woman's physician believes that this drug will reduce the impact of this disease on her, then I think she should be eligible for the drug," Ms. Horwath said.
And Conservative health critic Christine Elliott described the situation as "pretty appalling."
"She did everything she was supposed to do only to be told she can't get the help she needs," Ms. Elliott said.
While Ms. Matthews seemed to acknowledge it isn't right for patients in some parts of the country to be able to obtain publicly funded drugs while others cannot, she said Ottawa must take the lead in fixing the problem.
"It seems to me it's not right that whether or not someone gets certain drugs depends on what province they live in," Ms. Matthews said.
According to her spokeswoman, Neala Barton, the Ontario government is keen to pursue drug eligibility with other provinces. As a first step, Canada's health ministers are working on pooling their purchasing power for drugs and medical supplies, an initiative launched last summer, she said.
On Wednesday, Ms. Anzarut, mother to Benjamin, 4 and Laila, 2, begins her first day of chemotherapy, still uncertain whether the Herceptin she needs to start in May will be publicly funded. She says she will have to find a way to pay for it herself.
"I'm doing this for my daughter and my four young nieces. Nobody should have to do this," said Ms. Anzarut, her voice cracking. "I can't look my family in the face unless I tell them that I tried everything."Report Typo/Error