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Ontario 'failing' cancer patients

Critics ask province to fall in line with rest of Canada on access to PET scans

From Friday's Globe and Mail

Opposition health critics are calling on the Ontario government to provide cancer patients better access to PET scans, saying it is far too restrictive.

"We should get on with it so that Ontarians have the same access to this technology as patients in the majority of other provinces in Canada," Elizabeth Witmer, Progressive Conservative health critic, said in a telephone interview yesterday.

Ontario's NDP health critic Shelley Martel also joined the call for better access, charging yesterday that the provincial government is "using the PET trials as a means to delay ensuring [patients obtain] these tests under OHIP."

The comments follow a Globe and Mail story that revealed the limited access cancer patients have to the nine public PET machines in Ontario. That province's use of the scanners is so tightly controlled that when doctors at St. Joseph's Health Care London have been unable to fill their half of the PET/CT slots with cancer patients, researchers have used the empty spaces to do experiments on laboratory-bred animals, such as dogs and pigs.

Yet, cancer patients can easily access them in Quebec, which plans to do 21,000 scans next year. As well, patients can access PET scans in British Columbia, Alberta, Manitoba and, as of this month, New Brunswick. Nova Scotia also plans to buy a scanner and expects to have it operating by the fall of 2007.

PET stands for positron emission tomography. Patients are injected with a short-lived radioactive tracer isotope that has been mixed with a sugar called fluorodeoxyglucose. Cancer absorbs the glucose more readily than healthy tissue, causing it to light up on a scan.

A PET scan can pick up the metabolic signal of cancer cells. It can identify a lung cancer that has spread. A lymphoma patient may learn a lump is merely scar tissue. Colorectal cancer patients may find that the tumours on their liver can be safely removed. A scan can help assess when chemotherapy is not working, prompting doctors to change a drug cocktail.

PET scans need to be carefully interpreted, because non-cancerous conditions can appear to be cancer; only a biopsy can confirm the presence of cancer. But for some kinds of cancer, the PET can be more revealing than the CT scan. In 20 to 40 per cent of cases, cancer patients will have their treatment plan changed based on PET-scan results.

Christopher O'Brien, president of the Ontario Association of Nuclear Medicine, said yesterday that the ratio of scans to the Ontario population is one per 14,802 people, compared with Quebec where it is one for 362 people.

"We are falling behind the other provinces and failing our patients," Dr. O'Brien said. "The Ontario government is hiding behind flawed clinical trials and research to deny patients access to this vital diagnostic tool."

But Ontario Health Minister George Smitherman told reporters yesterday that an analysis is being conducted to determine when PET is best used in Ontario.

Currently, cancer patients can get access to PET machines under five clinical trials or through a patient registry introduced a year ago. But the registry is restricted to suspected recurrent colorectal, thyroid or germ-cell cancers and patients with certain solitary pulmonary nodules.

Lymphoma patients are not included, which is particularly disturbing to doctors. In those cases, PET scans can help determine what kind of chemotherapy should be used, and for how long; after treatment, they can distinguish whether bulky masses are scar tissue or cancer that has not been eradicated.

"We're very mindful that PET does offer particular opportunities, but you can't just make a diagnostic tool available willy-nilly," Mr. Smitherman said yesterday. "You really have to zone in specifically on those circumstances where it's particularly effective."

He said it was crucial to move forward in a way in which the scientific evidence backs its use.

"To enhance access before determining the places that it is most appropriately used would be to create a demand on the resource that might mean that those who would benefit the most wouldn't necessarily be able to access it," Mr. Smitherman said yesterday.

With a report from Karen Howlett

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