Drugs for cancer easy to get in B.C.

Access to cancer drugs varies dramatically by province, with British Columbia providing the quickest access to the most medications, according to a report card on the cancer system.
That contrasts with Ontario, where cumbersome review processes have made obtaining some of the newer cancer drugs a "nightmare," Kong Khoo, a Kelowna-based medical oncologist, told a packed news conference in Toronto yesterday.
"There's a huge amount of paperwork and difficulty accessing these drugs," Dr. Khoo said in releasing the Cancer Advocacy Coalition of Canada annual report card.
The coalition's review found that of the 24 cancer drugs studied, all of which represented key advances, B.C. covers the cost of providing 21 of them. In Ontario, only six such drugs had approved funding and Prince Edward Island was the lowest of any province with only four fully funded drugs.
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In Ontario, for example, Velcade does not have full, approved funding to treat a relapse of multiple myeloma, nor does Tarceva for non-small-cell lung cancer or Campath for relapsed chronic lymphocytic leukemia. Alimta, which is given with Cisplatin for mesothelioma, a rare form of cancer associated with asbestos exposure, also did not have full funding in Ontario as of late December, said Dr. Khoo, who is on the board of directors for the Cancer Advocacy Coalition of Canada, a non-profit group that receives unrestricted funding from a variety of pharmaceutical manufacturers.
Part of the problem, he said, is that not all provinces finance oral and intravenous cancer drugs through a centralized cancer agency in the way that B.C. does.
Some newer drugs are funded for the elderly but not the young, or through private insurance. Some drugs are available only through individual oncologists and hospitals. Some not at all.
As well, not all provinces are quick to fund cancer drugs, even when the scientific evidence is compelling.
For example, when a large, clinical trial in December, 2000, showed that Rituxin dramatically reduced the death rate for lymphoma in patients aged 60 to 80, B.C. approved and funded the drug three months later, in March, 2001, to its younger patients, as did New Brunswick.
By March, 2004, the death rate from lymphoma in B.C. had been reduced by half. Yet, it was only after lobbying from patient activists and an advocacy coalition, and media coverage that the drug was provided in Alberta and Ontario in the spring and summer of 2004, the report said.
The early introduction of Rituxin to lymphoma patients under 60 from March, 2001, to April, 2004, probably saved about 20 lives. However, during that same period, as many as 100 patients under 60 died of lymphoma in provinces where funding was delayed, the 47-page report said.
"The human tragedies accompanying these untimely deaths of relatively young people can only be imagined," said the report by the group, which comprises cancer specialists, health executives and patients' advocates. ". . . Had they been allowed to remain alive as productive and tax-paying citizens, they probably would have 'paid-off' the cost of their treatment in their ensuing working years."
Overall, the report said B.C. has the best funded and most timely access to cancer drugs and the best cancer outcomes and lowest mortality. Alberta provides only modest access to new cancer drugs. Although the report noted that Ontario has approved funding for only six drugs, it does provide limited access to 13 additional ones.
"It's come to a point where many of these drugs are new standards of care. If you don't give these things, you are medically liable, " Dr. Khoo said in an interview. He predicted that, in the future, "people will be dragging governments to court."
However, he did note that the cost of the newer cancer drugs is substantial, with 15 of them carrying a price tag of between $20,000 and $70,000 for a standard course of treatment, which ranged from 12 weeks to one year.
What all of this research shows, said Dr. William Hryniuk, chairman of the group's board of directors, is that Canada needs a catastrophic drug program.
Terrence Sullivan, president and chief executive officer of Cancer Care Ontario, said yesterday that the Drug Quality and Therapeutics Committee, which approves all cancer drugs in Ontario, is the most robust of its kind in the country.
He said the independent committee of leading medical oncologists, health economists and ethicists looks at the medical evidence on a drug's effectiveness and cost effectiveness, then recommends to the provincial government whether it should be funded.
"Nobody is telling those people what to say or what to think," Mr. Sullivan said. "They are working on good standards of evidence."
In an interview yesterday, Dr. Khoo said he is tracking the drugs province to province because he sees his fellow cancer specialists and patients struggling with the system.
"They can't say anything or they can and nobody listens," he said.