Advocacy > CCAC’s Advocacy Goals
The CCAC has four major goals for its Advocacy program: establish a national, population-based screening program for colorectal cancer; provide cancer patients with better access to treatments; support healthy lifestyles; and a letter-writing campaign directed at members of your provincial legislature.
A National Screening Program for Colorectal Cancer
Faced with the death of approximately 8,500 men and women annually, Canadians should be outraged knowing that most of these deaths could have been prevented. Any other disaster of such a magnitude that sustained equivalent losses year after year which were also preventable would certainly have called for a parliamentary inquiry. And Canadians would have demonstrated in the streets demanding to hold those responsible accountable for the unacceptable human loss and suffering and insisting on immediate action. Can you imagine the reaction of losses of this nature to our troops in Afghanistan on a monthly basis or perhaps the loss of more than two wide-bodied jets every month?
Colorectal cancer is highly preventable through regular screening and early detection. So why are we silently accepting these losses? Why are we not screening our population? Why have our provincial health ministries not created programs similar to those that exist for breast cancer or prostate cancer? In 2002, the National Committee on Colorectal Cancer Screening (NCCCS), comprised of an expert panel and key organizations from across the country, released its recommendations calling for population-based screening at least every two years with a fecal occult blood test (FOBT) for those between the ages of 50 and 74 years old. It was estimated that FOBT screening could reduce colorectal cancer mortality from 15 to 33 per cent. As new technology emerges, ultimately FOBT could be substituted for even more effective tests resulting in even lower mortality rates. Several provinces have conducted studies coming to similar conclusions. Ontario has even carried out a pilot project to examine FOBT testing in limited regions of the province to learn how to best implement such a program. Yet today, despite the thousands of lives that could have been saved since the release of the NCCCS recommendations, not one province has implemented such a program.
In 2005, approximately 19,600 people were diagnosed with colorectal cancer in Canada. Had screening programs been implemented we could have prevented thousands of these Canadians from having developed colorectal cancer. With early detection and treatment, the cure rate approaches 90 per cent, but detected in later stages, the cure rate falls to approximately 10 per cent.
To date, the Canadian experience in the treatment of colorectal cancer often lags behind other G7 countries that have already introduced colorectal cancer screening and primary prevention programs. Until such prevention programs are in place, our governments owe patients an even higher duty of care to ensure that they receive equal and timely access to treatment including, but not limited to, the latest medications that constitute the standard of care in the treatment of this disease. With long waiting lists to see general practitioners, gastroenterologists, surgeons and radiologists, lack of diagnostic and imaging equipment, a spotted experience across the country in the reimbursement of standard therapies and limited psycho-social support, Canadian patients are not obtaining the standard of care we are entitled to. The shameful fact is that when it concerns colorectal cancer in Canada, we are faced with unacceptable and preventable loss of life, unwarranted pain and suffering, and an escalating and staggering financial cost in the treatment of the disease. Common sense dictates that screening programs coupled with primary prevention programs must immediately be implemented to combat these inequities while at the same time addressing the desperate problems in the treatment of patients.
Better Access to Treatments
Colorectal cancer treatment has evolved rapidly in recent years. The first breakthrough occurred in the early 1990s, when doctors discovered a medication called leucovorin calcium that significantly increased the cancer-fighting power of the conventional chemotherapy Fluorouacil (5FU). Around 1998, new-generation agents like irinotecan (Camptosar) and oxaliplatin (Eloxatin) were added to the anti-colorectal cancer arsenal and an oral chemotherapy, Xeloda (capcetabine), arrived. About two years ago, still-newer ’biologics’ arrived: unlike standard chemotherapy drugs, targeted therapies like Avastin (bevacizumab) and Erbitux (cetuxamab) home in on factors that foster tumour growth, without harming healthy cells. (Avastin, for example, locks in on a protein that nurtures new blood vessel formation, thus starving tumours of nutrients.) Other medications such as Eprex (epoetin alfa) help patients to stay on their treatment longer keeping their red blood cell count up.
With the integration of these newer drugs into treatment regimens for patients with metastatic disease (cancer that’s spread beyond the original site), "Median survival rates have essentially doubled," notes Dr. Daniel Rayson, a medical oncologist at the QEII Health Sciences Centre in Halifax. But these therapies appear to hold even greater promise in adjuvant treatment - preventing recurrences of cancers caught at an earlier stage. "In the 1980s, your chances of being cured were 45 per cent, and now they’re about 70 per cent," says Dr. Felix Couture, director of the haematology/oncology service at the CHUQ/L’Hôtel-Dieu de Québec in Quebec City. "That’s what we’ve done in the adjuvant treatment of colon cancer."
Unfortunately, not all Canadians who could benefit from admittedly costly new therapies are able to access them outside of clinical trials, or special access programs. Some provincial formularies won’t pick up the tab for newer drugs, and regulatory roadblocks have delayed others from entering the Canadian marketplace- two things the Colorectal Cancer Association of Canada is trying to change. "These therapies are not for everybody, or for every situation," acknowledges Dr. Rayson, "but when they may provide meaningful benefit, everyone should be able to access them equivalently, no matter where they live."
One example is oxaliplatin (Eloxatin), a drug used in the systemic treatment of the disease in combination with other drugs. While regarded as a standard colorectal cancer treatment worldwide, a data protection issue has complicated the drug’s approval for distribution in Canada. As a result, the manufacturer has been subsidizing the drug’s cost in provinces where drug reimbursement programs do not have to pay for it. Ontario and Alberta have refused to cover the cost of the drug, leaving patients to pay for this therapy, at least in part.
The new targeted therapies are posing a special problem that has received high profile media attention. While forming part of the standard therapy for advanced disease in many other countries, provincial governments, worried about their drug budgets, have been debating the coverage of life-prolonging biologics such as bevacizumab (Avastin) and cetuximab (Erbitux). The Government of Saskatchewan, for example, says these drugs are too expensive and have refused to support the cost of Avastin.
The CCAC’s position is very clear. These systemic therapies are about prolonging the lives of patients with advanced disease. If we call colorectal cancer a chronic disease, we must treat it as such and offer patients treatments that afford long-term survival.
While there are many things we don’t understand about cancer, this much is clear: one-third of all cancer-related deaths in Canada can be prevented with healthier lifestyle choices.
It’s easy to forget that everything in our busy lives is contingent on our physical health. Make exercise an inviolate component of your schedule by blocking out time on your calendar. Remember that all physical activity helps. If you can’t make it to the gym four times a week, take a brisk walk around the neighbourhood each evening with your spouse or a friend. Just 150 minutes of moderate to vigorous exercise a week provides significant protection against illness.
Choose healthy, whole foods
Busy lifestyles also make it tempting to reach for high-fat, low-nutrient convenience foods. While we don’t yet know how the cancer-fighting mechanisms in food work, research has proven that a diet rich in cereal fibre, fruits and vegetables - and low in red meat - helps prevent cancer and other diseases. (For further protection, talk to your doctor about supplementing selenium, folic acid, vitamin D and calcium intake.)
Don’t smoke, drink alcohol in moderation
Tobacco use significantly increases the risk of colorectal and other cancers. It’s a tough addiction to overcome, but quitting as part of a whole-life wellness plan can help you beat the cravings. Use the time and energy you reclaim to prepare delicious, healthy meals and find physical activities you enjoy - celebrate your new freedom! Research also indicates that excessive use of alcohol may increase your risk for colorectal and other gastrointestinal cancers. Men shouldn’t have more than two drinks a day; women should limit intake to no more than one drink per day.
Every healthy choice you make improves your odds of avoiding disease in the future, while enjoying vibrant wellness today.