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Earlier discussion

Globe reporters answer cancer questions

Continued from Page 1

Erin Anderssen: One of the things that surprised me most about my work on the series was how cancer has become, in many cases, a chronic disease. I interviewed people who have been going through treatment, in one form or another, for roughly 10 years. I think we often imagine that cancer is the kind of illness for which you receive treatment, and then carry on. But treatment has its own side effects. And in a real way, cancer is chronic whether you are actively fighting it or not — it is one of those illnesses that has a huge psychological impact. You have to learn to live with the fear and worry of it coming back, or that it is lurking hidden somewhere inside you. It is also why it is seems like such an oversight not to focus more on the mental health of cancer patients.

Roy Preshaw from Saltspring BC writes: Question for Ms. Philp: You have eloquently extolled the virtues of complementary medicine and psychosocial support for those battling the diagnosis of cancer. In Ontario, your own therapy with herceptin is subsidized by the provincial government, but Ontario has so far refused to subsidize Avastin for metastatic colorectal cancer. In an ideal world, all cancer patients should have access to whatever form of care they choose to pursue. Given current financial constraints, would you prefer that Ontario spend more money on complementary medicine/psychosocial support for cancer patients -- or fund Avastin?

Margaret Philp: I don't see funding Avastin or funding psychosocial support as either-or propositions competing for the same dollars. The studies done in Canada on distress in cancer and efforts to diminish it have routinely shown that it saves money to offer cancer patients emotional support. They are less likely to go to emergency departments with side effects of their treatment or disease, and people with metastatic disease are far less likely to follow expensive, last-ditch chemotherapy regimens that seldom extend life for long and often greatly impact the quality of the patient's final weeks of life.

One meta-analysis of the research -- that is, a study that combines the findings of all the existing studies of the issue done to date -- concluded that providing psychological and emotional support to cancer patients cuts the cost of their medical treatment by 20 per cent. This is the financial argument, which says nothing of the compassionate urgency to deal with distress in cancer. Again, when we look at the research, the majority of cancer patients are suffering severe levels of distress following their diagnosis. Depression is very common. So if cancer care in Canada can take strides to soothe that distress and save money while they do, why would the system not embrace programs like support groups, yoga and meditation classes?

I have attended a fund-raiser for a friend who was raising money privately to cover the steep cost of Avastin to prolong her life long enough to see her three-year-old child attend grade one. When I was introduced to Herceptin, my oncologist told me I would have to pay $50,000 at a medical clinic in Buffalo, New York. I would never suggest psychosocial support instead of a life-saving or even life-prolonging treatment. Rather, this support is something I believe can only help with medical treatment.

Baldev Sood from Toronto writes: Some time I wonder that there is no political will in the world to have a healthy planet. Cancer is caused by not one but many factors. The major factors being environmental, i.e the air we breathe, water we drink and the chemical-laden food we eat, plus stress of the 21st century. We have let out a monster. How do we control this monster without political will?

Erin Anderssen: Thanks for your question. What struck me as I was interviewing many of the Canadians diagnosed with cancer was how often they told me that they didn't fall into any of the high risk factors: They ate well — many of them organic food products — they exercised, they were in good health. That certainly raises questions. I think we are still trying to figure out the causes of cancer — it is likely many factors, as you say. And certainly our concern about the environment should be based not just on reducing cancer rates.

Consumers also have control — in what foods we choose to buy, in what standards we insist on from our companies. Why we do insist on buying, for instance, so many bleached items — like paper towels, toilet paper and diapers — when we know the chemicals that this process releases into the environment? If more people made conscious decisions, a market would be created for more environmental products, and costs would come down.

In the course of researching the story, I had an interesting conversation with Simon Sutcliffe, who is head of the BC Cancer Agency and also vice-chair of the Canadian Partnership Against Cancer. He said that people are often focused on what the government can do to reduce cancer rates. But individuals also need to ask themselves what they can do — whether it be eating a healthier diet, getting more exercise, or being intentional consumers.

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