Earlier this week I sat down with an oncologist from Brampton, Ontario to ask about this oral versus intravenous issue and how it affects the patients he sees. He said quite plainly that ONE in every THREE patients he sees has trouble accessing cancer medications due to the cumbersome process for approvals.
It goes like this:
Oncologist makes the diagnoses and chooses the right drug, which just happens to be an oral drug.
Does patient have insurance? No. Then they have to fill out the forms for Trillium...sometimes there is a Medicines Reimbursement Specialist to help because this is an extensive process requiring income tax information from everyone in the household. Sometimes the patient has to do the paperwork themselves because one third of cancer centres don't have someone to help. Sometimes the patient is just overwhelmed and doesn't understand why they have to do this. Or has language issues. Or hasn't filed their taxes because they have been ill.
And then they wait... could be 4 weeks, could be 6 weeks for Trillium to get back to them.
The oncologist must also do the paperwork for the EAP program in Ontario (Exceptional Access Program). That application, along with the patient's medical information, will be reviewed by the EAP office (actually by an oncologist under contract with EAP) to determine eligibility. Sometimes the application is denied. And then the initial oncologist fills out more paperwork to appeal. (Of note: this is not the case for intravenous drugs from CCO. The oncologist makes the order online according to eligibility criteria.)
Six to eight weeks later, the patient has a second appointment. Their condition appears to have deteriorated. They still have no drug.
In Ontario, if this was an intravenous drug, Cancer Care Ontario has a mandate that all patients should wait no longer than 2 weeks from consult to first treatment. For oral cancer therapy, there is no mandated timeframe.
Patients wait for private insurance. They wait for Trillium. They wait for EAP. and they find out how much they will have to pay themselves. And how they will afford it.
Unfortunately cancer cells don't wait until the funding gets sorted out.
Tumours grow. Patients get sicker. And then they (we) lose our best chance to keep this disease in check.
Is that fair? We have a cancer system in Ontario. Let's make it a cancer system for all Ontarians for all cancers and all drugs that are provincially approved.