Cancer Advocacy Coalition of Canada

2007 Report Card on Cancer in Canada™

Media ConferenceToronto, February 12, 2008

Introduction and Overview

Dr. James Gowing

Our Findings

• Current Canadian system of managing cancer from research to treatment and supportive care is outdated

• As a consequence, cancer management is:• Inconsistent• Ineffective• Unfair to Canadians

Overview

• Cancer research funding – any change?• Clinical research – need for a paradigm shift?• Cancer in young adults – are they the forgotten generation?• PET scanning – why is Ontario so far behind?• Supportive Care – are nurses nursing patients?• Access to cancer drugs – is it getting worse?• Who pays for cancer drugs – do we have two-tier

medicine?

The Way Forward

• Greater collaboration between government and all other stakeholders

• Modernize our infrastructure for both research and access to care

• Motivate Canadians to demand better and equitable access to cancer care

If we choose, we can have access to the best quality cancer care.

Cancer Drug Access in CanadaPart III

Dr. Kong Khoo

Rosemary Colucci, William Hryniuk,Joseph Ragaz, Sandeep Sehdev and Colleen Savage

Cancer Drug Access in Canada – Part III

• New wave of cancer drugs• Report on 24 previous treatments plus 18 new

therapies

Status of Public Funding:24 Previously Studied Cancer Drugs by Province, 2007

0

5

10

15

20

25

30

BC AB SK MB ON QC NB PEI NS NL

Approved and Funded Limited access/fundingRecommended but not funded Not approved or funded

Status of Public Funding, 18 New Cancer Drugs/Indications by Province, 2007

02468

101214161820

BC AB SK MB ON QC NB PEI NS NL

Approved and Funded Limited access/fundingRecommended but not funded Not approved or funded

Summary of Findings

• Only a minority of the 18 new cancer drugs are widely available

• Access to cancer drugs remains highly variable across the country – “postal code lottery”

The Cost of Cancer Drugs in Canada

Dr. Kong Khoo

Rosemary Colucci, William Hryniuk,Robert Kamino, Tania Redina and Colleen Savage

The Payer Landscape for Cancer Drugs

• Public payers through provincial cancer agency or cancer centre/hospital budgets

• Public payer through provincial “pharmacare” plans• Private insurers/ insurance• Patient self-pay• Pharmaceutical company compassionate access, and

assistance and expanded access programs• Charitable/donated funds• Clinical trials

Drug Costs: Who is Paying?

• Last year we detected a trend to increased private funding for cancer drugs in Central and Atlantic Canada

• This year we investigated public vs. private payouts for new cancer drugs in each province on the Brogan Inc. public & private database

• Does variable payout for new cancer drugs correlate with the differences in cancer mortality from west to east?

Brogan Inc. Public & Private Drug Database

• Private Drug Plan Database• Drug benefit claims paid by most major private

insurers in Canada• No data for PEI

• Provincial Drug Plan Database• Represents provincial “pharmacare” programs

mainly for oral, take home cancer drugs• No data for PEI• There is little data for BC, AB, SK because most

cancer drugs are provided through provincial cancer agency drug budgets including oral take-home drugs

Drug Costs – Who’s Paying?

Both public and private insurance payers are paying more across Canada.

Drug Costs: Who is Paying More? Manitoba

Manitoba Public Versus Private Pay 2002 - 2006

$2,168,178

$3,416,742

$5,019,427

$5,866,510 $6,155,968

$173,155 $194,499 $358,801$644,101

$792,309

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

$7,000,000

2002 2003 2004 2005 2006

Public PayPrivate Pay

Drug Costs: Who is Paying More? Ontario

Ontario Public vs Private Pay 2002 - 2006

$15,682,044

$21,513,287

$37,071,888

$47,577,435

$7,189,772

$10,891,114

$18,554,513

$23,931,176

$31,546,729$29,476,693

$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

$40,000,000

$45,000,000

$50,000,000

2002 2003 2004 2005 2006

OntarioPublic

OntarioPrivate

Drug Costs: Who is Paying More? Quebec

Quebec Public Versus Private Pay 2002 - 2006

$11,569,921

$19,063,183

$24,161,718

$29,066,487

$36,081,890

$4,456,338

$8,587,851

$13,404,792

$17,257,802

$22,997,008

$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

$40,000,000

2002 2003 2004 2005 2006

Quebec PublicQuebec Private

Drug Costs: Who is Paying More? Atlantic

Atlantic Provinces Public Versus Private Payer 2002 - 2006

$1,692,015

$2,203,397

$2,782,125

$3,809,348

$4,724,712

$1,857,050

$2,583,278

$3,524,504

$5,154,610

$6,540,167

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

$7,000,000

2002 2003 2004 2005 2006

Public PayPrivate Pay

Who Pays? Private Insurance

Cost Per Incident Cancer Case By Private Insurance 2006

$81.07 $87.98

$33.00

$134.29

$551.52$600.44

$721.63

$383.62

$684.40

$456.46

$0.00

$100.00

$200.00

$300.00

$400.00

$500.00

$600.00

$700.00

$800.00

BC AB SK MB ON QC NB NS P EI NL

Est imated New C ancer Cases by Major C ancer S ite (Table 3, C anadian C ancer S tat ist ic s, 2006, page 24)

The Cost of Drugs – Who Pays?

Summary• The cost is rising rapidly for both public and

private payers for cancer drugs• Private insurers and patients in different parts of

the country bear very different burdens for the cost of cancer drugs

• If you have cancer, depending on your postal code:• A new cancer drug might be provided to you by

government• You may have to rely on your private insurance• You may have to pay for the drug yourself

Additional Highlights

Dr. William Hryniuk

Summary of the Other Key Articles

Inconsistent Ineffective Unfair

Drug Access X X X

Drug Payments X X X

Cancer Research Funding

X

Clinical Research X

Cancer Treatment in Young Adults

X X

PET Scan X X X

Supportive Care X X X

Cancer Research Funding in Canada

• Epidemic diseases historically controlled by prevention• Present grant system focused on the cancer cell not the cause• Using strict definitions of research, have found few changes

since 2004 Report Card• Government sponsored research agencies continue to

emphasize basic research of the cancer cell not the cause• Non-government organizations such as CCS and NCIC

making important, strategic shift to more treatment and prevention research

• Need to rethink research objectives and focus on societal priorities, not researchers’ priorities

Cancer Treatment ResearchParadigm Shift Needed

• The present infrastructure of clinical trials is becoming obsolete for the present era • Based on 1970’s approaches• Major bottleneck new curative agents backed up

waiting in queue to be tested.• Delays of introducing new curative agents into

practice• Inability to materialize their survival gains • Major loss of opportunity to avoid cancer deaths!

Cancer Treatment ResearchParadigm Shift Needed

• Reforms proposed for breast cancer • Five-point proposal package to reducing over-

investigation of these new curative agents presented to an international meeting

• If implemented, package has potential to save thousands of lives, and millions of dollars

Young Adults With Cancer: The Forgotten Generation• Young adults with cancer:

• Have the same chance of surviving cancer today as they did in the 1970’s

• Represent 28% of the potential life lost due to cancer • Deal with unique and challenging emotional issues as a result of

their stage of life• The Canadian healthcare system:

• Allocated less than 0.1% of new research funding to young adult cancer issues in 2006

• Delivers only four support groups for young adults in the whole country

• They are a generation that warrant a significant investment of resources to help them be the contributors and leaders they were destined to be

PET Scanning Why is Ontario So Far Behind?

• An innovation for diagnosis and management for cancer; ironically originated in Canada

• Ontario continues to lag far behind other provinces and the world in recognizing its utility

• Ontario requires unattainable standards of evidence for the utility of PET in clinical cancer medicine

• Ontario cancer patients suffer the consequences

Supportive Care The Role of Nurses

• Why supportive care?• Nurses ideally suited for providing supportive care• Historic evolution of nurses’ role• Nurses in major cancer centres only partially providing

supportive care• 32% of nursing hours spent on non-nursing duties• Redeployment of these hours would allow navigation of

cancer patients through the silos of the healthcare system and enhance primary care nursing

The Future “Re-thinking Cancer”

• Cancer research funding…greater focus on prevention• Clinical research…streamline to get results quicker • Cancer in young adults…invest now for high return• PET scanning…embrace modern technology• Supportive care…empower nurses to nurse• Access to cancer drugs…equal access to quality treatment• Cancer drug payment…redesign public/private payment

system

The Future

• End the postal code lottery• Develop a national vision for cancer care in

Canada • Usher in a new era of collaboration• Act with urgency

The 2007 Report Card on Cancer in CanadaTM

Thank Youwww.canceradvocacy.ca