Ontario’s Two-Tiered Cancer System is a Problem That Requires Immediate Treatment

CanCertainty Coalition Calls for an Integrated Cancer System that Equally Supports Patients Whether Treated in Hospital or at Home

Toronto, Ontario, March 21, 2016 – Your experience with cancer care in Ontario depends greatly on the type of cancer you have, the kind of treatment you are prescribed, your age and family income – all of which can make or break the timeliness and quality of care you receive.  Ontario’s two-tiered cancer drug system includes widely different drug reimbursement models and variable safety standards and support for patients who take their cancer medications at home versus in a hospital or cancer clinic.  

With Canada’s aging and growing population poised to drive up the number of cancer cases by 40 per cent by 2030,1  CanCertainty and a growing number of cancer organizations, including the Canadian Cancer Society, are calling for change in how the province funds and manages cancer drugs that can be taken at home.

“In a system where patients are supposed to come first, we’re seeing a divide between those treated in a hospital setting who receive first-class cancer care and those who are treated at home,” says Deb Maskens, kidney cancer patient, co-founder of both Kidney Cancer Canada and the CanCertainty Coalition. “If we are going to put patients first, we need a system that cares for all cancer patients equally – regardless of where they take their treatments.”

Today, with up to 60 per cent of drugs in the pipeline being in pill or self-injectable form, many people are taking cancer medications in the comfort of their own homes.2

“As an oncologist I want to be able to give my patients the right treatment at the right time – regardless of whether that’s at home or in a cancer clinic,” says Dr. Anil Kapoor, Uro-Oncologist, Juravinski Cancer Centre in Hamilton. “However, people on take-home cancer medication have to navigate a patchwork of drug programs and insurance plans to help pay for their medications and don’t benefit from the same safety systems, standards or patient counseling as those who receive IV therapy.  These patients deserve timely access to these medications, and the same funding and support as other patients treated in-hospital.”

Canadians believe cancer care should be a provincial government priority

In a recent survey of more than 1,400 residents of Ontario and the Atlantic Provinces, conducted on behalf of CanCertainty, respondents overwhelmingly (87 per cent) feel that people with cancer who take their medications at home should be monitored and supported by cancer-trained health care professionals in the same way as those who take their medication in-hospital.3  

According to a recent survey of oncologists from across Canada,4 two-thirds (65 per cent) of those polled in Ontario said they are concerned with the safety implications related to patients administering, storing and handling oncology medications in the home environment for patients, caregivers and family members and 95 per cent believe that patients taking their cancer medications at home should receive the same levels of funding, monitoring and support as patients who are receiving IV therapies in a hospital or cancer clinic.

“When my husband was diagnosed, we had to wait more than four weeks until we received his oral chemotherapy treatment because of all the required paperwork.  Then, we were shocked to learn that we had to wait yet again to renew his prescription because our local pharmacy needed to ‘special order’ the drug and did not want to store such an expensive medication at their store,” says Marianne Scott, a caregiver to her husband Paul who is being treated for kidney cancer. “We also needed to educate ourselves on how to handle the treatment and its side-effects.  Facing a cancer diagnosis is very scary and hard on families, but accessing treatment and support shouldn’t be.”

As stated in a Bulletin from the Institute for Safe Medication Practices in Canada, take-home cancer therapy transfers the responsibility for the management and monitoring of chemotherapy drugs to the patient, their family and their local community pharmacist, who may not have the appropriate training in this area.5,6,7  In hospitals or cancer centres, pharmacists receive special training to assist patients who are taking powerful drugs like chemotherapy.  

According to Cancer Care Ontario’s Think Tank Report: Enhancing the Delivery of Take-Home Cancer Therapies in Ontario released in December 2014, cancer patients receiving take-home medications in Ontario are facing formidable challenges related to safety, accessibility, equality and responsiveness – all of which affect the overall quality of patient care and effectiveness in the cancer system.8  As stated by CCO: “system oversight for take-home cancer medications should be consistent with the one in place for hospital-administered drugs.” Since the 2014 report was issued, plans have been slow to materialize.

Systemic Inconsistencies and Inequities Prompt Plea for Task Force

“While we are encouraged to see some small steps being taken to reduce cancer medication errors and increasing community pharmacists’ education, we are yet to see a commitment to resolve the unfair divide between in-hospital and at-home cancer care,” concluded Ms. Maskens. “As a next step, our Coalition is calling for a task force to be put in place to determine actionable steps based on CCO’s Think Tank Report.”

In British Columbia, Alberta, Saskatchewan, and Manitoba, provincial governments fully fund take-home medications like oral chemotherapy. In the Western-most provinces, take-home medications are also dispensed through designated cancer-related pharmacies, and patients receive counselling on how to take and handle their medications effectively and safely.  The British Columbia Cancer Agency for instance, provides full drug coverage for both take-home cancer medications and those administered in a hospital.  Take-home medications are dispensed through designated cancer-related pharmacies.  Patients also attend group chemotherapy lessons or receive one-on-one counseling from a pharmacist.  Similar programs exist in Alberta and Saskatchewan.

About the CanCertainty Coalition

The CanCertainty Coalition is the united voice of 35 Canadian patient groups, cancer health charities, and caregiver organizations from across the country, joining together with oncologists and cancer care professionals to significantly improve the affordability and accessibility of cancer treatment. For more information, visit www.CanCertainty.com.

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For more information, please contact:
Sheba Zaidi
Environics Communications
[email protected]


1. Canadian Cancer Society: Canadian Cancer Statistics 2015. https://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/
. Accessed on March 4, 2016.
2. Canadian Cancer Action Network: CADTH pCODR pipeline, Canadian Drug Pipeline Information for Patient Advocacy Groups, February 2016. https://www.cadth.ca/sites/default/files/pcodr/Communications/pCODR-CCAN_HTA_Pipeline.pdf. Accessed March 2016.
3. Strategic Directions Survey of 1,420 people from Ontario, Nova Scotia, Newfoundland, New Brunswick and PEI conducted between February 4th and 11th, 2016.  Results are considered to be accurate within +3.0%, 19 times out of 20.
4. OncologyEducation.com Survey of 65 oncologists from across Canada conducted between February 29 and March 10, 2016.
5. Abbott R, Edwards S, Whelan M, Edwards J, Dranitsaris G. Are community pharmacists equipped to ensure the safe use of oral anticancer therapy in the community setting? Results of a cross-country survey of community pharmacists in Canada. J Oncol Pharm Pract. 2014;20(1):29-39.
6. Neuss MN, Polovich M, McNiff K, Esper P, Gilmore TR, LeFebvre KB, et al. 2013 Updated American Society of Clinical Oncology/ Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. Oncol Nurs Forum. 2013;40(3):225-33.
7. Bartel SB. Safe practices and financial considerations in using oral chemotherapeutic agents. Am J Health Syst Pharm. 2007;64(9 Suppl 5):S8-S14.
8. Enhancing the Delivery of Take-Home Cancer Therapies in Canada. Cancer Care Ontario Proceedings Report. December 2014. P. 29.



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