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Cancer: Our National Shame
Lisa Priest, The Globe and Mail, 11-22-06

This is another illuminating, and disturbing, article from the Canadian Globe and Mail, highlighting how drug rationing in Canada affects the prospects of cancer research—and the health of cancer patients.

For the first time, Canada is unable to participate in a key clinical cancer trial because patients are not getting the best known treatment.

Since most provinces don't fund Avastin, a crucial drug in the fight against colorectal cancer, Canadian patients could not join a trial run by the National Cancer Institute in the United States, which is studying what drug is most effective with chemotherapy—Avastin or Erbitux—or if they work best given together.

If effect, if you don't pay, you can't play.

"Not only are we screwing our patients by not offering them the standard of care, the only way we can make advances is by running these clinical trials," Ralph Wong, a medical oncologist at St. Boniface General Hospital in Winnipeg. "... It makes us look like a Third World country."

At a time when provinces are taking a hard fiscal line, saying they will only fund cancer drugs proven to be cost–effective, they are hindering research that would provide the very answers they are seeking—and casting Canada in the role of scientific freeloader.

Used in the U.S. since 2004, Avastin, the trade name for bevacizumab, offers a median of an additional 4.7 months survival to patients with an incurable form of colorectal cancer. But that payoff isn't worth the price for most provinces. Ontario rejected the drug outright. Saskatchewan won't cover it either, although it allows patients to pay for a course of the drug—about $36,000—while the public system funds the infusion.

On the other hand, Newfoundland and Labrador does pay for Avastin, and the BC Cancer Agency permits some compassionate access to it. At least one Quebec hospital covers it.

The result of this payment hodgepodge is unequal treatment for Canadian patients—and now the unexpected side effect of impaired cancer research.

Canada can't participate in the clinical trial that would confirm whether Avastin should remain part of the standard of care for metastatic colorectal cancer because it does not uniformly provide that care today. Ralph Meyer, director designate of the National Cancer Institute of Canada's clinical trials group, said he knows of no other case where Canada went through the approval process, as it did with Avastin, only to withdraw.

But he predicted that it may happen again, given that some of the newer, more expensive cancer drugs are not uniformly covered across the country.

"There will be instances like this, where at this point in time, we won't be able to participate," Dr. Meyer said. "Could it potentially compromise certain types of research in Canada? Yes, it can."

"We find it very concerning and also very disturbing," added Dr. Wong. "We're supposed to be a First World country."

Although not a cure, Avastin is part of a new revolution of cancer drugs that works by preventing the growth of new blood vessels, which helps starve tumours, making it harder for cancers to grow.

...Dr. Moore said there is no question Avastin is effective. "The issue is an economic one," he said. "These drugs are expensive and the reason these drugs are not readily available in Canada is a cost-effectiveness argument."

Project FDA.
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