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Earlier discussion

Pat Kelly on Canada's cancer strategy

Globe and Mail Update

Forty per cent of Canadians will get cancer at some point in their lives. But under Canada's fragmented system, their treatment -- and their chances for survival -- will vary dramatically depending on where they live.

"There is an unofficial postal-code lottery, in which patients in less populous, poorer areas of the country, like the Atlantic region and the Far North, get short shrift," André Picard wrote in Saturday's Globe and Mail.

Now the Conservative government has announced the creation of a five-year, $260-million cancer strategy -- something that people like Pat Kelly, an advocate for the Campaign to Control Cancer, have been urging for years.

"Now we've got both funding and leadership, it's time to close the gap between what we know and what we do for every Canadian family," Ms. Kelly said after the government's announcement.

But how do we close that gap? What does the new cancer strategy mean? What remains to be done in the fight against cancer in Canada?

Ms. Kelly will be online this afternoon to answer your questions and share her thoughts.

Join the Conversation at that time, or submit a question in advance. Your questions and Ms. Kelly's replies will appear at the bottom of the page once the discussion begins.

Pat Kelly began her career in citizen advocacy in 1987, when as a young mother she was diagnosed with breast cancer. While employed as a technologist in immunology research at McMaster University, Pat helped establish networks of patient self-help groups. She also wrote and published six editions of the book, What You Need To Know About Breast Cancer, as well as three manuals for group facilitators.

Formerly a member of the Board of Directors of Princess Margaret Hospital, The Ontario Cancer Institute and The Ontario Cancer Treatment and Research Foundation, Ms. Kelly is currently the Program Director for the National Cancer Leadership Forum/Campaign to Control Cancer.

The Campaign to Control Cancer is a national coalition of more than 55 leading cancer organizations. They represent cancer nurses, doctors, patients, families, advocates, researchers, supporters and survivors. Their mission is to put everything we know to work preventing, detecting, treating­ and controlling cancer.

Ms. Kelly holds a Master's of Arts degree in Leadership and Learning from Royal Roads University in Victoria, BC. Ms. Kelly and her family make their home in Toronto, Ontario and in the mountains of Western North Carolina.

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Rebecca Dube, globeandmail.com: Hello Ms. Kelly, and thanks for joining us today. To start off, when the government announced its new cancer strategy, you said, "It's time to close the gap between what we know and what we do for every Canadian family." Could you tell us a bit more about that gap between what we know and what we're doing now -- how big is it? Who's falling through the cracks? Why have we as a country allowed that gap to persist for so long?

Pat Kelly: One of the biggest cancer myths is that our only hope lies in new research or the "magic bullet" in the distant future — in fact, if we applied what we already know about controlling cancer we could significantly reduce the number of new cancer cases — and some projections claim by as much as 50%. That means doing things like the following:

Breast Cancer: 22,200 diagnosed in 2006, 5,300 will die.
Impact of putting knowledge to work: Screening, mammography, clinical exams could reduce deaths by 40%

Colorectal Cancer: 20,000 diagnosed, 8,500 will die.
Impact of putting knowledge to work: Fecal occult blood test every two years could reduce deaths by 33%

Cervical Cancer: 1,350 diagnosed, 390 will die.
Impact of putting knowledge to work: 90% of deaths preventable with early screening/treatment

All cancers: 149,000 diagnosed, 70,000 will die.
Impact of putting knowledge to work: Overall rate of cancer deaths could be cut in half over next generation.

The gap is huge — and we can do something about it NOW — imagine if corporate Canada decided to get serious about cancer control by ensuring that all employees who were eligible got screened for colon, breast, and prostate cancers? What if there was a competition for the community that had the highest screening rates, or an award for the school board that created innovative programs in healthy living, or if every dental professional complied with the expectation that all patients be screened for oral cancer?

Its time to change the conversation about cancer from blaming governments to taking control by learning what to do for yourself, your family, your coworkers and employers and raising everyone's expectation for excellence.

Jim Connors from Dartmouth writes: I am interested in learning more about how Newfoundland and British Columbia came to approve Avistin for funding while other provinces continue to hold back. Is there anything that happened in those two provinces to obtain government approval that can be applied usefully in other provinces where colorectal cancer patients could benefit from this effective but catastrophically expensive drug? Any advice you may have as an "advocate" on how to maximize the chances of successfully lobbying other governments to recognize and fund this drug would be much appreciated.

Pat Kelly: Jim, you've nailed the single most pressing issue facing provincial cancer agencies — how will the provinces pay for new cancer drugs? Because the provinces must fund cancer services for their citizens, and each province has a separate decision-making process and subsequent formulary or approval process, and every province determines its own cancer control priorities, we spend a great deal of effort and resources coming to provincially-based decisions. Key influencers are the human resources required to make complex decisions in a timely manner — especially critical in view of the fact that cancer drugs are only considered curative if they work the first time a patient gets chemo — the political priority for cancer, the size of the patient population and therefore the magnitude of the problem. Ideally, decisions about access to drugs are based upon evidence of effectiveness -- but as you point out, each province operates independently in this regard and thus we have differences in availability — and most importantly, differences in mortality and quality of life for cancer patients.

Jeannie Hardie from Brownsburg-Chatham writes: I am a cancer survivor and want to know the latest developments in cancer treatments.

Pat Kelly: To Jeannie — YIKES!! Explaining the latest news in cancer treatments is beyond my meager human abilities. HOWEVER — as you are clearly computer-smart, you might look to some of the expert websites that are dedicated to keeping the public informed — including Oncolink, www.oncolink.org; the American Institute for Cancer Research, www.aicr.org; and the American Society for Clinical Oncology, www.asco.org.

I have a bias toward US-based cancer treatment information as I have found in my work that because they are client-focused and market-driven, these sites stay current, comprehensive and are not limited in terms of information provided.

R. M. from Regina writes: At the outset I hope you will pardon my cynicism, fuelled by year after year of government announcements and pronouncements and "new" funding. I just do not see how the following will occur, as quoted from the initial announcment of this program: "...it's going to mean that Canadians right across the country, wherever they live — whether it's in large centres with tertiary care or small communities — will have access to programs and services that are based on the best possible knowledge that's available out of international (medical) literature and local learning. I fail to see how the above "vision" can be possible (or for that matter is even defensible) for something as complex as human health and I certainly do not see how the small, by today's standards, approximately $50 million dollars [per year] can accomplish this goal.

Pat Kelly: Dear Skeptic on the prairie — I share your characteristic posture for critical thinking. But I am also a cancer survivor of 20 years and have worked as an advocate for almost all of those years. Be assured, this IS the Martin Luther King "I have a dream moment," in that now we have a common vision, a plan for change, the political will to keep cancer front and center — and the leadership to put the plan to work.

But like the civil rights movement, change won't come overnight. Like many cancers that take 8-10 years to grow from a microscopic spec to a lump that can be detected, Canada's cancer plan needs a chance to get started and grow stronger as more people share the vision for change. As more and more cancer professionals, cancer centers, provincial cancer agencies, charities and governments build strong commitments to Canada's cancer plan, applying what we know faster, doing things right every time, measuring and reporting to the public about both compliance and non-compliance and outcomes, we will measure our progress. Like the civil rights movement, it is the future generations who will feel the effects of these efforts much more than we will benefit today.

Jan McKim from Edmonton writes: I am a mother who has just lost her son to Melanoma Cancer on October 6, 2006. I could not believe how fast my son died. We were told there was no help that could stop the cancer from progressing. I became very frustrated. This cancer does not have anything that can stop it. I want to know why? There seems to be concentration on the "easy" types of cancer that they know can be stopped. What about the real bad cancer, the one that can jump from one place to another like a mosquito?

Pat Kelly: Dear Jan — First I must acknowledge the suffering you must feel in the loss of your son in such a sad and unfair circumstance. Your profound question comes from the suffering of a young man, far too soon. What all cancers have in common is that they are all caused by genes — genes that change and grow out of control. Some cancers, depending on where they start — breast, lung, prostate, and colon — take years to grow into a large mass or take years to metastasize and invade vital organs.

The other thing all cancers have in common is their unpredictability — sadly, no one can tell us what will happen to any single cancer patient. Cancer predications are based on "best guesses" about what happened in the past to large numbers of people who participated in clinical trials or took standard treatments. While many cancers have a good prognosis, your son's disease is very aggressive.

Progress in understanding the basic genetics of all cancers still offers the best hope for the future. Caring mothers like you and families who offer love and support must sadly step in where all else has failed.

Jeannie Hardie from Brownsburg-Chatham writes: What is being done to get people immediate access to oncologists and treatment?

Pat Kelly: Dear Jeannie — the shortage of cancer professionals reflects the failure of past efforts to adequately deliver on plans for the predicated increase in new cancer cases. Back in the early 1990s, Cancer Care Ontario advised the government that because of the aging population and new screening programs, along with progress in treatment, there would be dramatic increases in the number of new cancer cases. The government chose to ignore the advice of the experts — there were no efforts made to recruit and train cancer professionals — in fact, until very recently many of the qualified medical students who applied to become cancer specialists were refused entry to the programs because the provinces did not fund enough of these positions.

Without adequate cancer leadership at the political level, cancer agencies can plan and predict with great accuracy — but they cannot deliver without political will.

In the past two years, political will has begun to change and the danger of ignoring cancer professionals and their good advice is no longer acceptable. More cancer specialists are coming into the profession as doctors, nurses, dentists and pharmacist, and therapists of all kinds — because it is an exciting field with new opportunities.

Dee-Ann Schwanke from Edmonton writes: Hello, Ms. Kelly. Can you explain the relationship C2CC (The Campaign to Control Cancer) has with the government's strategy, if any?

Pat Kelly: Hi Dee-Ann — Great question. The C2CC is a broad-based coalition representing 55 of Canada's leading cancer organizations united to ensure funding and implementation of Canada's cancer plan.

Canada's cancer plan — called the Canadian Strategy for Cancer Control — did not actually come from government, at least not government acting alone. Canada's cancer plan came from our cancer community — doctors, nurses, patients, advocates and grass-roots cancer organizations. Through a diverse, evidence-based process, 700 participants helped to craft the plan, consistent with the World Health Organization principles on cancer control.

But despite having a good plan, these good people could not sell the plan to the decision-makers — politicians! Selling the plan to politicians required an external group that could lobby government on behalf of citizens. Although many of the people who lobbied government over the past two years to get the plan funded were the same people who helped craft the document — advocates, patients and families being a strongly represented group — we had to learn the fine art of co-operation, social marketing and media relations in order to gain first the attention of politicians and secondly the commitment of all parties to make this effort successful.

The C2CC represents cancer patients, professionals and grassroots organizations who have united with a common purpose — to change Canada's response to cancer — and we will remain involved in monitoring and advising as the plan is implemented.

Jeannie Hardie from Brownsburg-Chatham writes: What can the ordinary person do to help with this battle?

Pat Kelly: All Canadians can receive Stakeholder Alerts that provide timely advice about influencing decision-makers by joining the Campaign to Control Cancer (C2CC) by visiting our website and adding your voice at www.controlcancer.ca.

Rebecca Dube, globeandmail.com: That's all the time we have for today. Thanks to everyone who participated in the discussion, and thanks to Ms. Kelly for joining us online today. Ms. Kelly, any closing comments?

Pat Kelly: The G&M readers reflected the profound human suffering, struggles, concerns and cynicism about the current problems in cancer control — and while the current state cannot be denied, there is a great deal to be hopeful about at this time. In my 20 years of being a cancer survivor and advocate, there has not been a milestone of the magnitude of the Canadian Partnership against Cancer. It is not a cure — it is hope and that's the new beginning — even for skeptical old cancer patients like me!

On behalf of the 55 member organizations of the Campaign to Control Cancer, I offer my deep appreciation and thanks to the G&M for its pioneering inquiry into the state of cancer in our nation and to the readers who continue to seek answers and demand excellence in our federal and provincial cancer control efforts. Your efforts, coupled with those of all the others committed to change, will reach far beyond today. Merci — Pat Kelly, National Program Director, Campaign to Control Cancer.

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