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Cancer in Canada

Globe and Mail Update

In Saturday's Globe and Mail, Globe public health reporter André Picard tells the story of the evolution of Britain's cancer strategy -- and what Canada can learn from it.

In Heal, Britannia: U.K. gets cancer care right, he wrote: "In a country where cancer care is oft-described as our national shame, the partnership has its work cut out for it. But so too did Britain."

Mr. Picard was online earlier to take your questions on our health-care system's ability to cope with cancer in this country and the anticipated impact of the recently announced Canadian Partnership Against Cancer. Your questions and Mr. Picard's answers appear at the bottom of this page.

Mr. Picard has written extensively on public health issues and has been honoured by many bodies for his outstanding work over the years. He has been nominated for National Newspaper Awards in beat reporting for his work on such stories as the impact of the SARS outbreak on nurses; the dangers to young hockey players from body-checking; and the health effects of trans fatty acids. He has also been honoured numerous times by the Pan American Health Organization's Centennial Journalism award program, the Canadian Nurses Association; and has won the Canadian Policy Research Media Award and a Michener Award. Mr. Picard, who is based in Montreal, was on the forefront of reporting on Canada's tainted blood crisis in 1992, going on to write hundreds of stories about the men who died. He wrote On The Gift of Death: Confronting Canada's Tainted Blood Tragedy about this low point in Canada's health care history.

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Rasha Mourtada, globeandmail.com: Welcome, André, and thank you for coming online today to take globeandmail.com questions. While researching Heal, Britannia: U.K. gets cancer care right, what would you say stood out as the main disparity between our cancer care and theirs? What were you most struck by?

André Picard: Cancer care in Canada and Britain is very similar. Our hospitals look alike, we have specialized cancer doctors and institutions. Now we even have cancer strategies that are very similar. But what struck me most about Britain's approach was the co-ordination of care and the support provided to patients. British cancer patients have the benefit of "nurse-navigators" who assist them on the cancer journey. The nurse is an educator and an advocate, in addition to her regular duties as a healthcare professional. In Canada, there are a couple of nurse-navigator pilot projects but, unfortunately, they have not been rolled out nationally. The other big differences it that Britain has a national health system, and Canada has a far more complicated federal-provincial-territorial system. When the government of Tony Blair decided to implement a Cancer Plan, the National Health Service acted immediately.

Krista Clement, Canada: Britain was able to set national goals, funding, and processes within the NHS. Even with the new Canadian Partnership (and hurrah for them!!), we do not have a Canadian Healthcare System - we have a dozen provinces defending their turf. Will that difference become a massive speed bump to change in cancer care here?

André Picard: There is no question that the nature of our health system — 10 provinces, three territories and the federal government responsible for native, the RCMP and the military — makes it much more difficult to implement national strategies.

The new Canadian Partnership Against Cancer hopes to overcome those "speed bumps" by publishing good data, guidelines and policy recommendations and using moral suasion to have them implemented by the provinces. However, there is some troubling precedent. The Common Drug Review is a similar body that examines new drugs and determines whether they should be on provincial formularies but the final decision rests with individual provinces; whenever there is political heat, the provinces tend to back away from the recommendations.

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