Lack of firm deadlines for the provinces result in lengthy time lags in accessing treatment – which for some women could be a matter of life and death
OTTAWA, ON – October 13, 2015 – A new report released today from the Canadian Breast Cancer Network (CBCN), Waiting for Treatment: timely equitable access to drugs for metastatic breast cancer, is calling for more equitable access to treatments for the thousands of Canadian women living with metastatic breast cancer (mBC). Their research demonstrates an often two-year lag time (or longer) between provinces in listing drugs, which can result in life-or-death wait times for a woman with mBC. In order to achieve equitable access to potentially life-extending treatments CBCN has identified four specific areas that require improvement to help eliminate this inequity and allow for faster access to vital medications.
“Our country has a great system in place – but it’s not perfect. One of the biggest challenges is the lack of firm deadlines for the provinces to list a drug once it has been approved and pricing has been agreed upon,” says Cathy Ammendolea, Chair of the Board of Directors, CBCN. “Women in Quebec and Atlantic Canada in particular experience long delays in accessing treatment, causing enormous physical, emotional and financial strain on them and their families. Timely access to these medications is crucial.”
Currently, there are a number of obstacles blocking Canadian women from accessing treatment depending on their province of residence – some barriers include provincial formulary restrictions and drug listing wait times, although delays can occur at any of the four main stages of oncology drug approval.1 The four stages are:
- Review by Health Canada to approve a drug for sale in Canada – the means by which a drug application is reviewed by scientists at Health Canada, and on occasion, outside experts, to assess the safety, efficacy and quality of a drug2 ;
- Review by the pan-Canadian Drug Oncology Review (pCODR) – reviewing clinical and economic data for new treatments and making recommendations to the provinces and territories (except Quebec which is not a member but has its own review process);
- Negotiations by the pan-Canadian Pharmaceutical Alliance (pCPA) – a collaborative effort of the provinces to reach an agreement with the drug manufacturer on the drug price that will be available to all provinces that belong to pCPA; and
- Decision by each province and territory about whether they will list the drug on their formulary.
This lengthy review process often leaves patients waiting for long periods depending on where they live in Canada. Even patients with private insurance are impacted by waits, particularly if their insurance plans only cover those treatments listed on the provincial formulary.
Beyond the timing of when drugs get listed by each province, a further challenge that leads to inequity across the country is the disparity of restrictions provinces place on drugs that do get listed. These restrictions can dictate the order in which a woman might be required to select her course of treatment, or if she can access a medication at all depending on previous treatments.
“Today, there are several new, highly effective targeted treatment options available for women with breast cancer, but the challenges in accessing them for some can mean the difference in improved survival,” says Dr. Christine Brezden-Masley, medical oncologist and head of the department of hematology/oncology at St. Michael’s Hospital in Toronto. “Knowing there are alternate options out there, but being unable to offer them to your patient is a horrible feeling.”
ABOUT METASTATIC BREAST CANCER
October 13th is Metastatic Breast Cancer Awareness Day – an important time of empowerment for every Canadian woman and her family affected by mBC. Close to 1,200 Canadian women will be diagnosed with mBC this year3 and while mBC is considered incurable, there are treatment options that can help control the disease allowing many people to live with a good quality of life for many years. Metastatic breast cancer occurs when the cancer spreads to other areas of the body from the original cancer site, most often the bones, but also to the liver, lungs, brain and skin.4
“I have seen first-hand how these newer medications allow women with metastatic breast cancer to live longer and do so much more comfortably while going through treatment,” says George Govas, husband of a mBC patient. “I’ve been very vocal with my provincial government on the importance of providing access to these medications, and doing so in a timely manner – as it benefits the patient, their families, and the economy overall. The fact that there are significant disparities between provinces is unfair and needs to change. More options means survival – and survival means hope for these women – which impacts not just her but her entire family. If these treatments exist, why should people have to wait for them?”
THE CANADIAN BREAST CANCER NETWORK’S PILLARS FOR IMPROVEMENT
In support of all Canadian women affected by mBC, CBCN has identified four strategic pillars for improvement in the area of equitable access to treatment. The following is a snapshot of some of their recommendations:
- Support efforts toward faster and more equitable access to treatment drugs
- CBCN urges provinces slow to list drugs to their formulary to list them within a defined period of time.
- Increase knowledge and raise awareness
- CBCN will continue its initiatives to educate women about treatment options, treatment sequencing and differing provincial standards of care.
- Work with navigators in the health care system
- CBCN will engage with drug access navigators and other patient navigators within cancer care.
- Engage partners
- CBCN is prepared to engage partner organizations that share the goal of equitable access to cancer treatment drugs for all Canadians.
The Canadian Breast Cancer Network has identified mBC as a priority issue and that is why the organization is taking the lead in calling for equitable access to drug treatments in all regions of Canada. Visit CBCN.ca for more information and read the report to learn more on the issue.
The Canadian Breast Cancer Network (CBCN) is Canada's leading survivor-directed, national network of organizations and individuals concerned about breast cancer. The Canadian Breast Cancer Network is committed to ensuring the best quality of care for all Canadians affected by breast cancer and strives to voice the views and concerns of breast cancer survivors and patients through the promotion of information sharing, education and advocacy activities.
Craig Faucette / Niya Chari
Canadian Breast Cancer Network
613-230-3044 ext. 224 / 613-230-3044 ext. 231
firstname.lastname@example.org / email@example.com
- Waiting for Treatment: Timely access to drugs for metastatic breast cancer, October 2015. Available at CBCN.ca
- Health Canada Drugs and Health Products. How Drugs Are Reviewed In Canada. Accessed on September 10. Available at: http://www.hc-sc.gc.ca/dhp-mps/prodpharma/activit/fs-fi/reviewfs_examenfd-eng.php
- Canadian Partnership Against Cancer. The 2014 Cancer System Performance Report, March 2014. Available athttp://www.cancerview.ca/idc/groups/public/documents/webcontent/sp_report_2014.pdf
- Metastatic Breast Cancer in Canada – The lived experience of patients and caregivers. Canadian Breast Cancer Network and Rethink Breast Cancer 2013. Page 6. Available at /en/mbc_in_canada_2013