Ontario draws fire over cancer drugs

Funding procedure cited as reason for critical delays

The Globe and Mail
By Carolyn Abraham, Medical Reporter
Wednesday, July 13, 2005 Page A5

Ontario is attracting criticism as a slow provider of breakthrough cancer treatments, as its patients are once again left desperate for access to a critical drug -- this one available in every other province.

Just as women with a particularly aggressive form of breast cancer have been anxiously waiting for Ontario to fund the potentially life saving drug Herceptin, people with multiple myeloma, a fatal blood cancer, are agonizing over whether the province will pick up the tab for Velcade, a new treatment that could also extend their lives.

"I'm 49 years old and I want to live, this is my last chance," said Neil Koven, a father of two teenaged sons who was diagnosed with multiple myeloma two years ago. "I don't understand the politics, why one province doesn't allow this. . . . You can't hop the fence and get another provincial health-care plan to give it to you, you have to be a resident."

The struggle for Velcade is the latest example of patients falling through the widening gap between new medical treatments and the public's ability to pay for them.

Observers blame the delays on changes made this year to Ontario's drug-funding-approval process so provincial officials could conduct a more thorough cost-benefit analysis of expensive new treatments coming down the pipe.

"The overall theme is that these drugs are not getting approved, or they are not getting approved in a timely fashion," said Keith Stewart, a medical oncologist who treats patients with multiple myeloma at Toronto's Princess Margaret Hospital. "The result is that patients in Ontario cannot get access to a drug people can get in every other province."

Velcade is considered a drug of last resort and the first new medication in nearly 40 years for patients with multiple myeloma, a cancer that strikes the blood's plasma cells. More than 6,000 people in Canada have the disease, with 1,500 new cases diagnosed annually. Generally, Dr. Stewart said, people survive an average of five years after diagnosis.

However, Velcade is a new class of medication that can force cancer cells to choke on their own proteins. It has the potential to extend life by more than two years, or 13 months on average, Dr. Stewart said. Treatments cost about $35,000 a patient.

The U.S. Food and Drug Administration approved Velcade two years ago. Health Canada approved it in January. In Quebec, hospitals that have the discretion to decide on the drugs they will provide began offering it to patients not long after.

Ortho Biotech, which markets the drug in Canada, said all other provinces except Ontario provide Velcade through their cancer agencies and hospitals on a patient-by-patient basis.

But in Ontario, Judy Glennie, associate director of the drug programs branch of the Ministry of Health and Long Term Care, said only that "Velcade is in the review process," and that no decision had yet been made as to whether the drug would be funded.

Neither could Ms. Glennie say when a funding decision on Herceptin would be made, only that efforts are under way to "expedite" its review.

She said that in the past Cancer Care Ontario made recommendations on new cancer drugs and then applied once a year to the ministry to fund them.

But under the new system, which took effect in February, a subcommittee of medical experts and ethicists makes a recommendation on the comparative value of a new drug to another committee, which makes a further recommendation to the ministry.

"I think, frankly, Ontario has been leading the way in the review process," Ms. Glennie said. "We're doing our best to look at this evidence as quickly as [we] can."

Terry Sullivan, president and CEO of Cancer Care Ontario, acknowledged that bugs must be worked out of the new system to speed up decisions, but he said Ontario's situation is not much different than other provinces.

"There is no province outside of B.C. that is paying for Herceptin on an as-needed basis," Dr. Sullivan said.

In the meantime, Dr. Koven, a podiatrist who ran his own practice in Mississauga, Ont., until he was too sick to work, is left wondering what he will do next.

Although he has already refinanced his home to pay the bills, Dr. Koven said he is considering how to get the drug he needs, now that chemotherapy, radiation and even a stem cell, bone-marrow transplant have left him with no other options.

Dr. Stewart, who ran clinical trials of Velcade and is a consultant for Ortho, said some patients are heading to Buffalo, but noted that "It's a difficult drug to go out of town to get," as it has to be administered intravenously twice a week.