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Clinics let cancer patients purchase treatment

Drugs not covered by medicare fetch up to $40,000

From Thursday's Globe and Mail

For the first time, cancer patients across Canada will be offered what the public health-care system has been unable to deliver: intravenous drugs not covered by medicare for those who want to prolong their lives or fend off a recurrence -- for a price.

In what could be likened to one-stop shopping, patients can buy cancer medicine not paid for by their provincial governments, and in some cases, receive financial assistance. Medication will be administered by a nurse, under a doctor's supervision, in one of 18 infusion clinics across Canada.

Three key players are providing the service: Roche Canada, a drug company that holds the licence for five cancer products; McKesson Canada, which is administering the program; and Bayshore Infusion Clinics Inc., which provides clinical staff and medical equipment.

It's not clear how many patients would use the service. However, those requiring Avastin -- a drug proven to prolong the lives of patients with incurable colorectal cancer -- could tally in the thousands. Drugs to treat lymphoma and breast cancer would also be available.

The drugs don't come cheap: Price tags range from $22,000 to $40,000 for a course of therapy, depending on the medicine. A financial-assistance program can mean a discount as long as patients subject themselves to a means test.

The sheer number of clinics -- seven now operating, with 11 more set to open in January -- suggests there will be a large demand.

"We're offering a service to patients in need," said Janet Daglish, project manager for Bayshore.

The company is operating infusion clinics in London, Ont., Mississauga, Hamilton and Halifax, as well as two in Toronto and soon one in Brampton, just west of Toronto. Ms. Daglish said 11 more are to open in Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba and British Columbia next month.

The inability of the public system to cover the drugs comes as a surprise to cancer patients, who have long believed Canada's health-care system is based on the principle of equal access. But equality has never been the case when it comes to drugs, a vexing reality that often unfolds in the oncologist's office.

That is creating two types of cancer patients: those who can afford the best treatment and those who cannot -- what many would construe as two-tier care.

Sandy Sehdev, a medical oncologist who practises in Brampton, sees the infusion service as a stopgap, what he calls a "solution born out of necessity."

Consequently, he has turned the small room where his bookkeeper once worked into a makeshift infusion clinic.

He plans to open it to patients any day now, saying: "I want my patients to receive the same care that I would want to give my family."

Doctors have no financial stake in the business but are required to supervise the infusions.

In Dr. Sehdev's case, he plans to bill the public system $25 or $65 a patient, depending on the complexity of the treatment -- the standard fees for overseeing chemotherapy.

The opening of these clinics comes as governments fund some costly cancer drugs but not others, making for unequal access.

Most provincial governments prohibit hospitals from infusing unfunded intravenous drugs, though some Ontario hospitals quietly perform the service and absorb the infusion cost.

Providing such a service in hospital has been viewed as a violation of the Canada Health Act as it could be construed as paying for a medically necessary service.

The Ontario government is reviewing a proposal by Cancer Care Ontario, which suggested in July that patients be allowed to buy unfunded drugs and have them infused in hospital for a fee, from $250 a visit up to $2,500.

The absence of a government policy has been a stumbling block for many drug companies, eager to get their cancer medicine to patients but also wanting to turn a bigger profit by expanding their market.

Kong Khoo, a medical oncologist in Kelowna, B.C., who is a board vice-chairman of the Cancer Advocacy Coalition of Canada, said the private system will find a way to do what the public system won't.

"Private clinics are blossoming everywhere. I think you will see more and more of them."

Dr. Khoo said that if he developed cancer, he would want to ensure he had a good nest egg, which he defined as being $40,000 to $50,000.

But not every cancer patient has that kind of money, leaving oncologists in the middle of a health-care dilemma.

"Legally, morally and ethically, we have to tell patients what the evidence is for a drug, if it is a benefit and whether it's funded or not," Dr. Sehdev said.

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