Ontario to expand access to some cancer drugs
TORONTO - Ontario is expanding access to certain cancer drugs in the wake of a controversy sparked by a breast cancer patient who was denied a potentially life-saving treatment because her tumour was deemed too small.
Jill Anzarut, 35, ignited the firestorm after she publicly complained that the province refused to pay for Herceptin because her tumour was a half-centimetre in diameter. Only tumours larger than one centimetre qualify in Ontario.
Patients with smaller tumours can get Herceptin in British Columbia, Alberta and Saskatchewan, while some other provinces provide it on a case-by-case basis.
Health Minister Deb Matthews announced Monday that Ontario would allow "conditional" expanded coverage for some cancer drugs where there is evidence that it could have benefits beyond the current criteria for coverage.
"We want to work with the drug companies to find the evidence, to build the evidence, to determine whether or not we should expand access, expand the criteria of drugs that we already fund," she said.
But it's still unclear which drugs would be considered or what conditions might be placed on access to the drugs.
"In fact, I don't even know what drugs will be covered," Matthews said. "I have been told that Herceptin is a leading candidate for this kind of program. But I do not know what drugs and I certainly do not know what individuals (will qualify)."
Those decisions will be left up to Cancer Care Ontario and a provincial committee that makes drug funding recommendations, she added. The new guidelines should be in place by May -- the same month that Anzarut was told she should start treatment.
Anzarut, who has already undergone surgery and started chemotherapy, said she's "cautiously optimistic" about the new rules.
"It's not entirely clear to me what that means for me personally," she said. "But nonetheless, the announcement means that many other women who are in a similar situation to me will now have access to drugs if they don't exactly fit the bill."
Matthews' announcement came just a few days after Ontario's ombudsman announced he would investigate the matter, and the minister herself insisted it would be wrong to interfere in the approval process.
"We cannot have a health system where the stories that land on the front page of the paper determine our health-care policy," she told the legislature on March 10.
That same day, Anzarut learned her appeal to get the drug -- which costs about $40,000 -- had been denied.
But the minister, who is facing an election in the fall, insisted Monday that the province had been considering the changes "for some time."
Ontario makes decisions on which drugs to fund based on medical evidence, Matthews said. But she acknowledged that there have been "cases in the media" that made her realize that evidence isn't just "black and white."
The published evidence on Herceptin, for example, doesn't deal with the drug's effectiveness on small tumours, she said. But that doesn't mean it doesn't work on them.
"There have been cases that have shed light on this issue of the gap in evidence, the grey areas in evidence," she said. "There have been a number of situations that have been brought to my attention."
The Progressive Conservatives argue pre-election pressure from an outraged public and the ombudsman forced the government to make the "stunning reversal" on drug policy.
"I think it's just because there's so much pressure now from so many different sources that they needed to change course and change tack," said deputy Opposition leader Christine Elliott. "Not necessarily because they felt it was the right thing to do, but because they had to politically, and that's not the way we should be operating things."
NDP Leader Andrea Horwath slammed Matthews for taking two weeks to acknowledge that there's something wrong with a system that pits bureaucrats against cancer patients.
"People don't want rule books thrown at them," she said. "They want the health care that they need when they need it."
If the government was considering changes before Anzarut went public with her story, they shouldn't have stayed silent while she went through the ordeal of fighting the province while battling breast cancer, Horwath said.
"It's cruel, to say the least," she said.
In 2009, the governing Liberals extended public funding of the cancer drug Avastin two months after ombudsman Andre Marin accused the government of verging on "cruelty" by cutting off funding after 16 treatments.