Oncologists say life-saving cancer drugs are often out of reach for those without private insurance.
Long waits for cancer drug approvals in Canada mean some patients die before they can try treatments that might have helped them, say oncologists and patient groups who are calling for better access to oncology drugs.
“Cancer patients don’t have time to wait,” said Barry D. Stein, one of the authors of the Call to Action recently published in the medical journal Current Oncology. He is a colorectal cancer patient and president of the Colorectal Cancer Association of Canada.
It also means there is a growing disparity between patients who have private insurance and can get access to costly new treatments earlier and those who have to wait for them to become available through provincially funded plans or hope for compassionate access to drugs that could help them live longer or improve their quality of life.
He worked in the U.S. briefly, until the disparities between people’s access to health care in the U.S. system began to get to him.
The medical oncologist at The Ottawa Hospital cancer centre said he is now seeing similar disparities in Canada when it comes to access to new cancer drugs. It is a daily occurrence for Sehdev to tell a patient there is a treatment available, approved by Health Canada, that could improve their health, but it is not yet available. Those with enough money or with private insurance plans that will cover the cost can often get the drug.
“It happens every day,” Sehdev said. “I don’t like disparities. Canadians don’t like unfairness. I can live with having or not having a medicine if I don’t think there is value. But for the rich to get it and insured people to get it and others not to is frustrating.”
Ontario Premier Doug Ford, meanwhile, has talked about the need to speed up access to new publicly funded drugs. The issue is expected to come up at meetings of Canada’s premiers and territorial leaders later this week. Ford is the current chair of the Council of the Federation.
Access to drugs is not the only burden being borne by cancer patients in Canada. This week the Canadian Cancer Society issued a report that estimates that cancer is costing patients an average of $33,000 in out-of-pocket costs. Some forego parts of their treatment for financial reasons.
Meanwhile, there are concerns about access to cardiovascular drugs in Canada as well. A study published in the Canadian Journal of Cardiology and co-led by Dr. Morgane Laverdure and Dr. Derek So, both of the division of cardiology at the University of Ottawa Heart Institute, found that access to cardiovascular medications in Canada is not consistent among provinces and territories. The study said there is “substantial redundancy” with multiple tiers of agencies in drug approval processes across provinces and territories.
Authors of the study also found that close to one-quarter of all formulary decisions they studied (based on which treatments would be funded) were discordant with Canadian treatment guidelines and there are no protocols in place in any province to permit timely updates of formularies to account for novel evidence in cardiac drugs or to change pricing. They also found that newer medications are disproportionately less reimbursed.
“The current system leads to significant inequities, with Canadians residing in different provinces having varied access to different evidence-based medications and treatment,” said So. While solutions are being explored, he said the situation may compromise the health of Canadians, especially those relying on publicly funded drug plans.
Oncologists and patient advocates also say the delays in approvals are compromising the health of cancer patients.
“We are all aligned among patient groups across the country that the time to access new drugs is far, far too long, compared to other countries. There has to be a better framework. Other countries are doing it,” said Stein, who heads the Colorectal Cancer Association of Canada.
The paper published in Current Oncology found that not only does Canada lag behind other countries but public drug reimbursement timelines are continuing to increase “detrimentally impacting cancer patients.”
These disparities between Canada and other countries, the authors wrote, are partly attributable to “complex, overlapping sequential multi-step regulatory and funding processes involving federal, provincial, and private authorities and different provincial and private payers.”
Health Canada is the regulatory body that decides whether a drug is safe. After that, there are a series of other regulatory hurdles and negotiations before patients can get access to a drug through provincially funded plans. One of the final steps involves negotiations to agree on a price, but even after a price is agreed on, there can be lengthy delays before provinces begin paying for the drug.
Sehdev said Health Canada approval lags about six months behind many other countries, but it has joined Project Orbis, along with the U.S. FDA, Singapore, Australia, Brazil, Switzerland, the UK, and Israel, which aims to give patients faster access to promising cancer treatments around the globe. The rest of the process can add a year or more.
Timely access to treatment is now a leading barrier in managing cancer treatment.
Sehdev would like to see Canada follow what some other countries are doing and provide access to drugs even before negotiations to agree on a price are complete.
He said he agrees with the premise of Common Sense Oncology that money should not be spent on drugs that have marginal value, and he noted that most patients want drugs that meaningfully improve their quality of life.
But the authors of the paper say their findings about delayed access to cancer drugs “confirms clinicians’ observations that patients who would likely have benefited from new treatments are dying without having the opportunity to try them.”
Close to 250,000 Canadians will be diagnosed with cancer this year and 88,000 Canadians will die. It is the leading cause of death in Canada.