Are Provinces taking too long to approve potentially life-saving cancer drugs in your opinion? Tell us what you think about these delays,.
Provinces taking too long to approve potentially life-saving cancer drugs: study
Christina Commisso, CTVNews.ca Writer
Published Thursday, July 17, 2014 10:02AM EDT
Last Updated Thursday, July 17, 2014 10:44AM EDT
Canada’s two-tiered process of approving potentially life-saving oncology drugs is preventing cancer patients in some provinces from accessing medication that’s readily available in other parts of the country, according to a new study.
The study, released by conservative think-tank Fraser Institute on Thursday, looks at the effectiveness of the pan-Canadian Oncology Drug Review (pCODR), which was established in 2010 to recommend new cancer drugs to all the provinces and territories, except Quebec.
While pCODR recommends drugs for approval, provinces are not required to accept their recommendations. The result is certain cancer drugs are covered by provincial health care plans in some provinces, but not others.
“For negative recommendations, the provinces generally agree. For recommendations that are favourable, for provinces it’s sort of a ‘maybe,’ or whenever (the provinces) can actually afford to fund these drugs,” study author Nigel Rawson told CTV’s Canada AM on Thursday.
Rawson said, in many cases, the key factor keeping drugs from being approved is cost.
“They are expensive because they are (used) for difficult cancers or cancers that are late-stage,” he said. “There are often not a lot of patients projected for these drugs, and they take a long while to develop.”
The study also found that, while the pCODR’s aims to take between five and eight months to review a drug, some reviews take up to 10 months. It could then take a province up to a year to conduct their own review of the drug before deciding whether it will be covered.
The average time between a pCODR recommendation and provincial approval is the longest in Newfoundland and Labrador, where it was measured at 366 days. The average time spans in the other provinces:
- New Brunswick, 339 days
- Prince Edward Island, 309 days
- Manitoba, 249 days
- Nova Scotia, 218 days
- British Columbia, 197 days
- Alberta, 183 days
- Saskatchewan, 154 days
- Ontario, 150 days
“A lot of these patients, they’re projected life expectancy isn’t too great,” Rawson pointed out.
The study referenced the struggle of an Ontario mother suffering from late-stage brain cancer who lobbied the provincial government to fund a cancer drug that could have prolonged her life.
Kimm Fletcher, a 41-year-old mother of two, went public with her fight to have the province help cover the cost of Avastin — a cancer drug that’s covered for brain cancer treatment in Manitoba, British Columbia and Saskatchewan.
In Ontario, however, the drug is only covered for patients with colon cancer.
Fletcher died of cancer earlier this year.
Rawson said many cancer patients are forced to turn to donations from family and friends to pay for unfunded drugs, while others forego the treatment all together.
The study recommends some ways to improve the current system.
Rawson recommends that provinces make a commitment to accept a “reasonable proportion” of these drugs.
“The pCODR has provided positive recommendations for just over 80 per cent of these products,” he said. “It would be appropriate, in my opinion, for the provinces to make a commitment to take a high proportion of these products within a reasonable amount of time — like 120 days.”
Rawson added that the drug approval process in Canada is fragmented, as Ottawa is responsible for looking at the safety and efficacy of the drug, while the provinces look at the drug’s cost-effectiveness and makes the ultimate decision on whether it will be funded.
“The alternative is to take a national approach to providing funding for these drugs,” he said. “That’s more ideal, but more difficult.”
In a statement to CTV News, the pCODR says it welcomes the Fraser Institute assessment.
Study Links Heavy Use of Antibiotics To Risk for Colorectal Cancer
Chicago—The use of certain antibiotics is associated with an increased risk for colorectal cancer, according to a case–control study involving roughly 100,000 patients.
Antibiotics may reduce overall bacterial diversity, which can have substantial consequences on the functional stability of microbiota in the colon. Previously, research in mice and humans has suggested that tumor tissues from colon cancers have lower levels of microbial diversity and enrichment of certain bacterial strains (PLoS One 2011;6:e20447;Gastroenterology 2014;146:1534-1546).
“The study suggests that long-term and repeated antibiotic exposure might increase colorectal cancer risk,” said Ben Boursi, MD, a medical oncologist from the Integrated Cancer Prevention Center in Tel Aviv Sourasky Medical Center, in Israel, who led the study. Dr. Boursi’s group presented its findings at the 2014 annual meeting of the American Society of Clinical Oncology (abstract 1599).
The researchers evaluated the association between the type, timing, cumulative duration and intensity of antibiotic exposure and colorectal cancer (CRC) risk, using data from the Health Improvement Network. This population-representative electronic medical records database in the United Kingdom contains information on 11.7 million patients, with follow-up as long as 18 years.
The investigators identified cases of CRC, excluding patients with a known family history of CRC or inflammatory bowel disease and those who were diagnosed with CRC before the age of 40 years. These patients were matched with up to four controls based on age, sex, practice site and duration of follow-up.
Dr. Boursi and his colleagues controlled for known risk factors for CRC, including obesity, diabetes, smoking, alcohol consumption, chronic use of aspirin and nonsteroidal anti-inflammatory drugs, as well as previous screening colonoscopies.
The risk for developing CRC was increased by 6% in patients first exposed to penicillin more than one year prior to diagnosis (P=0.002), and remained statistically significant for patients who used penicillin more than 10 years before a diagnosis of cancer, with an odds ratio (OR) of 1.11. The risk increased significantly with the number of exposures to penicillin, with ORs ranging from 1.10 for one to five courses, to 1.2 for more than 10 courses (P<0.0001). The adjusted risk increase associated with each additional antibiotic course per year was 4% on average (P=0.008).
“This is the first study that has looked at whether or not, from an epidemiological standpoint, there is an association between antibiotic use, which is a very common exposure in the population, and colorectal cancer,” said Yu-Xiao Yang, MD, assistant professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, in Philadelphia, and senior researcher on the study.
According to Dr. Yang, the differences in effect likely show that “different antibiotics behave differently on different bacterial populations.” Future studies could try to find the mechanism by which antibiotics could be influencing cancer incidence.
“There are certain bacteria that might promote a pro-inflammatory environment,” Dr. Yang said. “Others may alter or generate toxins that might potentially be carcinogenic or might transform certain dietary or intestinal content into carcinogenic components. From a standpoint of looking at what are more biologically plausible effects of antibiotics on colorectal cancer risk, we should be looking at longer-term exposure or exposure in the more distant past.”
Richard Peek, MD, director of the Division of Gastroenterology at Vanderbilt University Medical Center, in Nashville, Tenn., who was not involved with the study, called the research significant.
“This is a very large study evaluating the effect of past exposure to multiple antibiotics on colorectal cancer risk. It is hypothesis-generating, and provides a framework for more detailed mechanistic studies to be performed that can determine the cause of this effect,” Dr. Peek toldGastroenterology & Endoscopy News. “This study adds to the growing body of literature supporting the role of the microbiota on diseases that develop within the gastrointestinal tract. It would be helpful to discern whether particular combinations of antibiotics exert a synergistic effect on cancer risk.”
Dr. Peek added that “the opportunity to enhance the diversity of the microbiome may be a strategy that can raise the threshold for malignant transformation. However, this requires much more detailed study.”
Drs. Boursi, Peek and Yang reported no relevant financial conflicts of interest.
Colorectal Cancer: Immediate Impact of 2014 ASCO Presentations on Clinical Practice
In an effort to provide you with timely market feedback from ASCO 2014, OBR and MDoutlook are pleased to share results from MDoutlook’s OncoPolls™ from the meeting. This first report explored presentations in colorectal cancers (CRC).
- Primary research phase involved a global survey to verified and validated medical oncologists and multi-disciplinary physicians with an identified clinical interest in gastrointestinal cancers utilizing targeting parameters within the proprietary MDoutlook® global cancer treater database
- Timing: June 2014. Launched two days after close of 2014 American Society of Clinical Oncology (ASCO) Annual Meeting, held in Chicago, IL., May 30-June 3, 2014
- Fielding via <10 minute long interactive internet survey utilizing proven effective methodology via the MDoutlook survey tool
- Links to discussed abstracts on the ASCO website were provided within the survey
- Reponses at data collection: 50 on June 24th
- No financial incentives provided for participation
Geographic Distribution of Respondents
Attendance at 2014 ASCO Annual Meeting
- Nearly three quarters of survey respondents attended this year’s ASCO annual meeting
- Higher proportion of attendees than in previous years (typically has been a 50/50 split)
Survey Participants’ GI Cancer Patient Flow: Average Over 13 Cases Each Month
- Survey participants* averaged 35 cases of colorectal cancer last 3 months
- More than all other gastrointestinal cancers combined
- Cases of pancreatic cancer were much more common than HCC
* Survey Participants = Medical Oncologists with an identified clinical interest in gastrointestinal cancers
Inclusion of Bevacizumab or Cetuximab with 1st Line Chemotherapy for KRASWT mCRC: Impact of the CALGB/SWOG 80405 Trial
- Results of the CALGB/SWOG 80405 Trial are not going to change treatment usage in the 1st line setting
- Small increases in cetuximab usage are expected, but not at the expense of bevacizumab
- Inclusion of biologics with chemotherapy for 1st line setting is going to remain the standard of care
- FOLFOX is and will remain the standard chemotherapy backbone for mCRC
Adjuvant Chemotherapy for Localized Rectal Cancer: Impact of the ADORE Trial Results
- Oncologists recognize the clinical importance of the ADORE trial
- Over half rate the presentation as important or higher
- Due to these results, usage of adjuvant therapy for stage II rectal cancer is expected to increase by over 1/3 from current levels
- Usage will be nearly 60% of the amount for stage III disease
- Widespread usage of adjuvant therapy for stage III disease will continue
- Slight increase to 80% of cases
Conclusions: Impact of ASCO 2014 on Clinical Practices for Colorectal Cancers
- Colorectal cancer is the main type of gastrointestinal cancers seen in clinical practices
- Oncologists’ patient flow in colorectal cancer is ~85% of their GI cancer patient flow
- FOLFOX + bevacizumab is and will remain the most common 1st line treatment approach for KRASWT metastatic colorectal cancer
- Minor increases in usage of cetuximab are expected, but not at the expense of bevacizumab
- Chemotherapy with a biologic is the standard of care in the 1st line setting
- FOLFOX will continue to be preferred over FOLFIRI
- Adjuvant chemotherapy is seen as an important therapeutic approach for stage II and III rectal cancers
- A 35% increase in its usage for stage II disease is expected, so that nearly half of patients will receive it
- Widespread usage for stage III disease will expand even more, to 80% of patients
- Oncologists use a wide variety of sources to learn about the results presented at ASCO
For a more detailed analysis report, please click here to download the full report.
Submitted by Robert Stephan, Sr. Director Medical Services and Strategy; Jessica Harnisch, Assoc. Global Medical Analyst; Justin Boag, Consultant; and Jan Heybroek, President MDoutlook.
- See more at: http://www.obroncology.com/blog/2014/06/1944/#sthash%2Ew1m9fkiN%2Edpuf
The Giant Colon Tour made an appearance at Allan Gardens in Downtown Toronto as part of the 10 day World Pride festivities. Personnel from the Toronto Central Regional Cancer Program and the Canadian Cancer Society joined the CCAC team to greet and inform Ontario residents, as well as visitors from all over the world, on colorectal cancer screening.
Special thanks to Laura McDonald of the Toronto Central Regional Cancer Program and Dr. Ed Kucharski, primary care lead for the Toronto Central Local Health Integration Network, Cancer Care Ontario, for being the driving force behind this most successful public awareness event.
Jaime Martino, Director of Operations for Pride Toronto was instrumental in providing this fantastic venue to showcase the CCAC’s magnificent interactive 40 foot Giant Colon. Jessica and all the on-site crew were very supportive and helped make the day pleasant for everyone involved.
We are grateful to Bariatrix Nutrition for being so generous in providing additional funding for this very special colorectal cancer awareness event.
Not even the cold and rain could keep runners from crossing the finish line on April 27th at Parc Jean Drapeau to raise funds for the CCAC.
Almost all our runners surpassed their fundraising goals. The CCAC would like to give a big shout out to Jacqueline Hopmeyer who raised $1,163.
Thanks to all who ran for us and to those running this summer in their own cities. For more information on the upcoming Scotia Runs in your city please click on the links below or contact Elyse at the CCAC for registration info.
On March 7th 2014, The Bentley, Yorkton, SK. hosted a fundraiser event called “Let’s sing our butts off for Colorectal Cancer.” It was a fun entertaining evening that gave everyone the chance to live out their rock star dream while adorned from head to toe in Blue! A variety of appetizers and drinks were served and there were raffle prizes to be won. The event raised $705.00!
This fundraiser hit home with quite a few residents. Some have battled the disease and won, some have lost a loved one to the disease and others are going though it right now. A big thanks to all the residents for opening up their home to help raise awareness and to show support.
Colorectal Cancer isn’t a topic that everyone loves to talk about. Our guest speaker of the night, Lorna Scott was eager to address the elephant in the room. Her knowledge and personal story left everyone with some keys facts and touching words.
‘Why be concerned about colon cancer? Well, it is the second leading cancer-related killer in Canada among men and women combined. So let’s talk about it!!’ Was one of the clear messages Lorna wanted to convey.
Lorna is a volunteer with the CCAC and she provided attendees with an informative presentation of signs and symptoms regarding colorectal cancer. Colon cancer is the most preventable and beatable cancer if detected early. That’s why we need to encourage everyone age 50 or older to get screened. Lorna also shared her own story about her husband, who passed away from colorectal cancer. Through her loss, she has written a book that helps others to find peace, hope and joy during a time when they may feel surrounded by darkness and sadness. It is the blend of her story as a caregiver for her husband, the lessons she learned along the way, encouragement about speaking to your doctor, and her inspirational words that serve to help others find their own peace, hope and joy.
Another great highlight of the evening was the excitement of the raffle prizes. Many thanks to our raffle sponsors as half of the funds raised would not have been possible without the wonderful prizes donated.
Special thanks to Jen Fitzpatrick, Executive Director at The Bentley Yorkton Revera – Retirement Living for organizing the event!
Did you know that colorectal cancer is the second-leading cause of cancer deaths in Canada? This year 23,900 men and women will be diagnosed with the disease and sadly over 9,200 individuals will die from it. However, this cancer is preventable, treatable and beatable in 90% of cases if discovered early.
March is Colorectal Cancer Awareness month, and the Colorectal Cancer Association of Canada (CCAC) will be hosting its second-annual, Dress in Blue Day on Friday, March 7th. We have been asking schools, business, and organizations all across Canada to show their support for colorectal cancer awareness by dressing in blue.
Partaking in Dress in Blue Day is easy. Similar to Denim Day where participants wear denim to benefit the CURE Foundation, on Dress in Blue Day participants wear blue to support The Colorectal Cancer Association of Canada and those affected by colorectal cancer. The CCAC would like to partner with you to spread awareness and fundraise for colorectal cancer. Please encourage your colleagues, friends & family to participate as well.
The CCAC is dedicated to increasing awareness of colorectal cancer, supporting patients, and advocating for accessible services, and would be happy to provide resources for you. These include healthy-eating pamphlets and informational posters which can be displayed in your office or distributed to your staff. There is no cost to participate in this event, but the CCAC strongly encourages everyone to donate to help support colorectal cancer; even a few dollars can truly make a difference. To register for this event, for more information or to make a donation please visit: ccac.donordrive.com
World Cancer Day is an event designed to reach out to the public on a global scale with the intent to educate and activate conversations about a disease that has effected and continues to affect millions of people around the world.
This year, World Cancer Day 2014 (4 February 2014) focuses on Target 5 of the World Cancer Declaration: Reduce stigma and dispel myths about cancer, under the tagline “Debunk the myths”.
According to organizers, World Cancer Day is a chance to raise our collective voices in the name of improving general knowledge around cancer and dismissing misconceptions about the disease. From a global level, we are focusing our messaging on the four myths above. In addition to being in-line with our global advocacy goals, these overarching myths leave a lot of flexibility for members, partners and supporters to adapt and expand on for their own needs.
Visit the website for more details on World Cancer Day and the 658 events organized and on-going around the world today. One of which is the presence of The Giant Colon Tour in the Mars Building in Toronto.
The 40-foot long, eight-foot high inflatable exhibit, which features many unappealing pre-cancerous and cancerous sites throughout, is an attention-grabbing prop used as part of the Colorectal Cancer Awareness Association’s awareness raising campaign on the second leading cause of cancer deaths in Canada.
Visitors are guided through the colon by a puppet mascot, Dr. Preventino, who appears on a series of screens to show them giant hemorrhoids, rectal cancer, mushroom-like polyps and other not-so-pleasant things one might see during a colonoscopy. The tour aims to inform visitors in a fun, graphic and memorable way, that colorectal cancer is both preventable and treatable.
The tour aims to inform visitors in a fun, graphic and memorable way, that colorectal cancer is both preventable and treatable.
If you haven’t had the chance to take a tour yet, it will be set-up in the Mars building today Feb 4th until 8:30PM.
Get in there while you can!
The Colorectal Cancer Association of Canada was pleased to accept a generous donation of $65,000 from Sanofi Canada and it’s employees to fund its vital awareness, support and advocacy activities.
Sanofi Canada employees were encouraged to take an educational tour of the CCAC’s 40’ long, walk through, multi- media, supersized representation of the human Colon that was installed at their annual National Meeting, on January 21 and 22. For each employee who took the tour, Sanofi Canada pledged to donate $5 to the association.
“With over 400 employees having taken The Giant Colon tour, many more than once, employees raised almost $6,500 for the Colorectal Cancer Association of Canada. As a result of their overwhelming support of the fundraising effort, Sanofi Canada decided to add a zero to the amount and raise the donation to $65,000,” claims Jon Fairest, President and CEO, Sanofi Canada. “Our goal is to be a true partner in health to Canadians and this is one way we achieve this. We are proud to partner with and contribute to the association and the important work it does.”
“We greatly appreciate our long-standing relationship with Sanofi Canada and ongoing support they provide the Colorectal Cancer Association of Canada in our efforts to increase awareness and education of the disease. With Sanofi’s help The Giant Colon became a reality in Canada, the result of which has been that millions of Canadians have learned about colorectal cancer and how it can be prevented,” said Barry D. Stein, President, Colorectal Cancer Association of Canada.
In 2013, 1 in 13 men and 1 in 15 women were diagnosed with colorectal cancer in Canada. Colorectal cancer is linked to several modifiable risk factors, emphasizing the importance of primary prevention and timely screening.
Stay tuned to our Facebook Page in order to know when The Giant Colon will be making a stop in a city near you!
The Colorectal Cancer Association of Canada (CCAC) in collaboration with the Canadian Oncology Societies (COS), OncologyEducation.com and the Groupe d’étude en oncologie du Québec (GEOQ) is proud to host an international expert-level conference chaired by Dr. Jean Maroun (Ottawa Hospital) and Dr. Axel Grothey (Mayo Clinic) entitled Personalized Medicine in the Management of Colorectal Cancer in Montreal, Quebec on November 5th and 6th, 2013, to promote a better understanding of how medicine and society are preparing for a new age in cancer treatment.
With advances in technology and a progressive understanding of cancer biology, personalized medicine is being applied in cancer diagnosis and treatment. Knowledge of a patient’s genetic makeup is driving the selection of the most effective therapies and the personalized medicine approach to the treatment of colorectal cancer will help physicians detect cancer earlier and improve patient outcomes.
This multidisciplinary meeting will cover how these concepts are being incorporated into today’s clinical practices, to an audience of clinical researchers, members of the pharmaceutical industry, government regulatory authorities, healthcare management organisations, physicians, patients, oncologists, and others in the healthcare community. At a time when health care is evolving rapidly, this expert conference will highlight how we are preparing the landscape for the adoption of personalized medicine in the clinic.
WHO SHOULD ATTEND
Physicians (family practice, epidemiology, GI, surgical oncology, pathology, medical and radiation oncology, interventional radiology, nuclear medicine, and psychosocial oncology) medical students and other health professionals, clinician-researchers and scientists, genetic counsellors, nurse practitioners and physician assistants, laboratory professionals, bioinformaticians, medical informaticians and information technology professionals, pharmacists, bioethicists, interested public, patients, and regulatory authorities.
Science and medical media are welcome.
CME CREDITS GRANTED
This event is approved for up to 9.5 credits by the Office for Continuing Health Professional Education (CHPE). The Office for CHPE, Faculty of Medicine, McGill University is fully accredited by the Committee on Accreditation of Canadian Medical Education (CACME).
This event is an Accredited Group Learning Activity as defined by the Maintenance of Certification program of the Royal College of Physicians and Surgeons of Canada.
Each physician should claim only credit commensurate with the extent of their participation in the activity.
The entire proceedings will be available to the public live at www.cos.ca.
Loews Hotel Vogue
1425, rue de la Montagne
Montréal (Québec) H3G 1Z3
Online at: www.personalizedmedpersonalisee.com