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Cancer: Our national shame

The killing cost of drug treatment

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Consider Robert Gill, 41, who was diagnosed last year with acute myeloid leukemia, a cancer of the blood and bone marrow. He was forced to take out a bank loan to pay his $1,000-a-month drug bill to deal with the complications of a bone-marrow transplant -- drug costs that exceed his $820 monthly disability benefits under the Canada Pension Plan.

Since Mr. Gill, who lives in Botwood, Nfld., makes more on disability than those on social assistance, he says he cannot qualify for a provincial drug card, which would cover most of his medication costs.

"How do I survive?" Mr. Gill asked. "It doesn't give you any incentive. I try hard, every day I'm fighting this, but it's hard when you can't get any help."

Amelia Loder, 69, from Grand Bank, Nfld., found that when she required drugs for her non-Hodgkins lymphoma, being a senior didn't help. While other provinces provide coverage to some if not all seniors, household income counts in Newfoundland, and her fisherman husband's pay was too high to qualify her for a drug card.

Consequently, since last year she has spent more than $3,000 on all her drugs, including those for cancer, of which $1,100 was offset by a town fundraiser. In the spring of 2006, she obtained a drug card that will cover many of her current and future medications.

And then there's Ms. Morey, the former short-order cook and mother of two young girls, Victoria, 6, and Robyn Ann, 4.

With no benefits through her husband's seasonal logging work, she racked up $4,000 in drug expenses, mostly in oral anti-nausea and anti-pain medication, and $6,000 more for travel, food and lodging when she journeyed the 500 kilometres to St. John's for several operations and other treatment. Her annual household income, for a family of four, was only about $27,500.

"There were times when I would look at that $30 [anti-nausea] pill and I didn't know when I was next going to be able to afford it," said Ms. Morey, who was supposed to take three of them a day. "I thought, 'I'm going to wait until I am really sick, then take them.' "

To cut costs, some cancer patients do what Ms. Morey did: They ration their drugs and suffer pain and nausea.

Knowing death is near, others arrange to die in hospital to avoid prescription-drug costs, according to a study by Maria Mathews, associate professor of health policy and health-care delivery at Memorial University of Newfoundland.

Dr. Mathews, the principal investigator of the study, said her findings suggest the Newfoundland and Labrador government should expand the drug program to cover the cost of all approved drugs for all patients with cancer, whether or not they are in hospital.

"Our medicare system only covers the drugs given in hospital," Dr. Mathews said. "For other things, it really depends on what province you live in."

A primary goal of the National Pharmaceuticals Strategy, a federal-provincial task force formed in 2004, was to ensure Canadians have coverage for catastrophic drugs, which are medications so expensive or used in such quantities that they cause financial hardship. While many provinces have found ways to pay for those costs, Atlantic Canada has not.

"The idea is to address those 600,000 Atlantic Canadians who don't have any drug coverage," said Bob Nakagawa, assistant deputy minister of pharmaceutical services in British Columbia, who is chair of the strategy's assistant deputy minister committee.

"Those are the ones that really come to mind, who don't have access, no matter how rich or poor or old or young they are."

Sharon Sholzberg-Gray, president and chief executive officer of the Canadian Healthcare Association, a federation of provincial and territorial health care associations, said governments are not moving fast enough. Only the principles of a catastrophic drug plan have been agreed to -- not a program, she said.

"We need it now because we have people who have no access to drugs," said Ms. Sholzberg-Gray. "It doesn't make sense to give patients drugs in the hospital but not when they leave the hospital, especially since these drugs keep people out of the hospital."

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