Kimm Fletcher was never one to back away from a challenge. While many terminally ill patients understandably retreat to put their lives in order and wait for the end, the Ontario wife and mother of two chose to fight publicly for a treatment that might have prolonged her life.
Suffering from an aggressive type of brain cancer, she spoke out in the media and confronted the provincial government about why Avastin, a cancer drug paid for in three other provinces, would not be funded for her. Her compelling story helped shed light on the push for a nationwide drug-funding system that advocates say is needed to resolve discrepancies that are unfair to Canadians.
"She didn't go looking for the fight," said her husband, Scott Fletcher. "But when it came to her she didn't back down."
Kimm Fletcher was born in Montreal on Oct. 3, 1972, to Keith Poirier, a line splicer for Bell Canada, and his wife, Marilyn. She would be the middle child between her brother, Terry, and sister, Robin.
The family followed her father's job, moving first to James Bay and then ending up in Oakville, Ont., in the early 1980s. Ms. Fletcher attended White Oaks High School, graduating in 1991. She then took a two-year program at nearby Sheridan College as preparation to pursue her dream of becoming a police officer.
She went to B.C., where she found work as a security guard, but eventually moved back to Ontario. She was working in security at the Westin Harbour Castle in Toronto in 1998 when she met Mr. Fletcher, another Oakville resident who had also gone to White Oaks.
"We had the same group of acquaintances in high school, but we didn't know each other," Mr. Fletcher said. "I played sports and had jobs. Kimm had friends and hung out."
Years later, a mutual friend decided it was time they connect and invited them both to a party at her place. "Kimm showed up in her overalls because our friend failed to tell her I was coming," he laughed. But Scott, who was building and racing stock cars at the time, wasn't put off by her lack of sartorial preparedness. He took her to dinner.
"We talked all through the night and were never apart after that," he said. She was his "French-Canadian, Roman Catholic, red-headed Libra." They married on Oct. 9, 1999, and made their home in Oakville.
Following in her father's footsteps, Ms. Fletcher trained as a line splicer for a Bell subcontractor, a job that was lost in a massive layoff. She spent the last eight years of her working life as bilingual customer relations agent for Osram Sylvania and its sister company Siemens Healthcare in Mississauga. After their son, Keidon, was born in 2003, Mr. Fletcher went to work at Bodine Manufacturing in Smithville, Ont. By the time their second child, Martie, was born in 2006, they had moved north of Oakville to Milton.
Their life was a "typical married life," Mr. Fletcher said. When he and his wife weren't working, they spent time with Keidon and Martie, swimming and enjoying sports, especially soccer. Ms. Fletcher also loved to sing.
Their normal life ended on Jan. 24, 2010, when she had her first seizure. Two days later her brain tumour was diagnosed. A couple of weeks after that, it was removed. She had six weeks of radiation therapy in March and April and the cancer was declared in remission.
"This changed how she wanted to live her life," Mr. Fletcher said, and she began dedicating even more time to the kids. Mr. Fletcher quit his job to cut down on commuting time and they bought an auto detailing franchise in Milton.
In June of last year Ms. Fletcher began feeling fatigued and disoriented. An MRI scan revealed a small "blip." By July the blip had grown to the point where another surgery was needed. Though the doctors said the operation went well, within a week Ms. Fletcher was in bed again and another scan revealed a tumour growing out of control.
"They said, 'You've got six to 18 months to live with Avastin and one to three months without it," Mr. Fletcher said. The problem was that Avastin, which costs $4,300 per treatment, is not covered under the provincial health plan as a treatment for brain cancer.
The manufacturer, Hoffmann-La Roche Ltd., has been turned down three times even though Health Canada approved the treatment in 2010. According to corporate relations manager Naziah Lasi-Tejani, the kind of tumour Ms. Fletcher had, called glioblastoma multiforme (GBM) accounts for about 43 per cent of all primary brain cancers. "After initial treatment, the cancer nearly always returns with a very poor prognosis for the patient," Ms. Lasi-Tejani said, adding that the company plans to continue to work to have the drug approved nationwide to help people suffering from the disease.
The drug is covered for brain cancer in British Columbia, Saskatchewan and Manitoba. The Fletchers felt even more frustrated when they learned that Ontario pays for it to treat patients with colon cancer, which has a better prognosis.
In keeping with her can-do approach to life, Ms. Fletcher went to work to raise funds that would buy her more time to create memories for her children. "She was beyond tough," Mr. Fletcher said. "She was a take-charge kind of person. It was in her nature to see what she could do to get things fixed."
The family paid what they could for treatment and over six months raised more than $111,000 on a fundraising website. "Her story hit a chord with a lot of people," Mr. Fletcher said. And it attracted widespread media attention.
In October she met with provincial Health Minister Deb Matthews, saying publicly that just one treatment of Avastin meant that she was able to get out of bed and walk her daughter to school. Ms. Matthews acknowledged that her situation was tragic, but stood by the decision that had been made.
Megan Winkler, director of community engagement for the Brain Tumour Foundation of Canada in London, Ont., said Kimm's story is not unique and that many patients are frustrated when they see a drug turned down in Ontario on the same clinical evidence that allows it to be covered in other provinces. What was different about Ms. Fletcher, though, was her determination to speak out.
"We want to see more equitable access to medication," Ms. Winkler said. "And the only way things change is if the voices are really, really loud."
David Jensen, media relations co-ordinator for the Ministry of Health, responded in an e-mail to questions about the drug approval process.
"The ministry's Committee to Evaluate reviews and considers the drug's clinical value and conducts a thorough assessment of the scientific and clinical evidence contained in the manufacturer's submission, cost effectiveness, patient values, as well as the impact on health services compared to existing treatments."
He said the province has also taken into consideration recommendations issued by the pan-Canadian Oncology Drug Review.
The committee assessed Avastin for brain tumours in 2010 and 2011 and recommended not to fund it "because the treatment has not been proven to prolong survival and the clinical benefit compared to treatment cost is unknown."
The manufacturer's third submission in 2013 was also turned down after an evaluation by the Ontario Steering Committee of Cancer Drugs. "The committee noted that new clinical evidence did not convincingly show that single-agent Avastin improves overall survival or quality of life in patients with recurrent GBM," Mr. Jensen said. "Furthermore, it is uncertain whether this treatment is cost-effective."
After the third application was turned down, Ms. Fletcher's hopes began to fade. "She wasn't really sad or angry," Mr. Fletcher said. "She was more disappointed in the system."
In February she had a visual seizure that made her realize the tumour was winning, and she began to prepare mentally for the end she knew was coming.
The family's last outing was a trip at the end of March to Great Wolf Lodge in Niagara Falls to celebrate Martie's birthday. Ms. Fletcher made it to the water park in a wheelchair.
"Each week her health declined a little more," Mr. Fletcher said. She accepted it knowing that she had fought the best she could.
Ms. Fletcher died peacefully at Ian Anderson House hospice in Oakville on April 27 surrounded by the most important people in her life. She was 41.
"There were all the right people in the room," Mr. Fletcher said, adding that a chance appearance of a deer outside as she passed away brought him a little comfort.
"When she was a Junior Ranger, she had the nickname Fawn," he said.