Rationing of cancer drugs defies 'duty of care'

Hey there, time traveller!
This article was published 14/9/2007 (4675 days ago), so information in it may no longer be current.

ONCE again Manitobans have seen a show of self-congratulations that never seems to end. Recently, taxpayers were informed by the Doer government that it had tripled the size of the rainy day fund since it was first elected. That fund is now at $663 million.

At the same time, Health Minister Theresa Oswald and CancerCare Manitoba have stated that they cannot afford to cover the cost of the life-extending drug Avastin to colon cancer patients.

In September 2005, when Avastin was approved by Health Canada, it was deemed to be the biggest advance in colon cancer therapy in years. Therefore, it became the "standard of care" for colon cancer in all G7 countries, Australia, Japan and even Oman and Libya. Even in Canada, British Columbia, Newfoundland and Labrador and Quebec provide the drug to patients.

According to Ms. Oswald, the Winnipeg Regional Health Authority and CancerCare Manitoba have recommended the use of Avastin in Manitoba as a first-line treatment of Stage 4 metastatic colorectal cancer. However, since June of 2006, Manitoba has dispensed Avastin to a small number of patients. Many patients who meet the criteria for treatment are being denied access to this treatment since CancerCare Manitoba "cannot afford it." That is no excuse when the province is sitting on a $600 million-plus nest egg!

Avastin, like most chemotherapies, is not a cure; however, it has two specific benefits. CancerCare Manitoba likes to quote survival rates of 4.1 months for the drug, but the latest research presented in the spring at the American Society of Clinical Oncology showed the length of time that no progression of the cancer was noticed was 11.1 months. The study authors cited a supporting study at the MD Anderson Center that resulted in a median for progression-free survival of more than 12 months.

Since Avastin dries up the necessary blood supply to the tumours, there is also the possibility of reduction in both the size and number of the malignant tumours. Oncologists say that may make patients, who previously were not able to have surgery, operable.

CancerCare Manitoba claims the cost of the drug is too high and they cannot afford it. Yet the drug Herceptin, given to breast cancer patients, is more expensive. Patients who received Avastin through CancerCare had approximately six to 10 treatments, at an average cost of $2,000 per treatment. Granted, some chemotherapies have been deemed more effective in maintaining life for a longer period of time and perhaps the cost/benefit seems to be greater. But why discriminate against colon cancer victims, especially since the health system has a "duty of care" to these patients. There has been no major effort to implement a screening process for colon cancer, even though the provinces agreed to do so in 2002. Manitoba announced it would begin screening in the spring of this year. Where is it?

For those people who can afford to pay approximately $2,000 per visit (every two weeks), their oncologist can refer them to a private infusion clinic. Those few who receive Avastin through CancerCare Manitoba and people who work for the federal government -- whose health care benefits are partially funded by taxpayers -- have their expenses covered. Therefore, some patients are paying for others to receive the drug while being denied that same right.

If you cannot afford to pay for the drug, you do without, or, as in some cases, you mortgage your home, fundraise or find some other means to pay. As if the stress of metastatic cancer is not enough for the patient and the family.

The unfairness of a system that treats people differently because of cost is one that the taxpayers should not tolerate, especially when the provincial government gloats about "tripling the rainy day fund."

Since Avastin has been found to be effective in the treatment of other forms of cancer, such as breast and lung, the provincial government is going to be faced with even more difficult decisions.

Oncologists in Winnipeg say there are approximately 200 patients who would benefit from Avastin, yet CancerCare Manitoba says it is only paying for about 10 patients. Who else will be refused the health care that they have paid for through their taxes? The Doer government should provide CancerCare Manitoba with the necessary funds to guarantee access to the drug for all patients whose oncologists recommend it.

Kai Arnot is a retired high school teacher who, in January 2004, was diagnosed with metastatic colon cancer. She is an advocate for the disease and the availablity of Avastin, which she is ineligible to take for treatment due to other medications.