The CanCertainty Coalition recently ran a survey of over 1800 Canadians asking each just 10 questions about their expectations about cancer care in their province. In total, 1370 Canadians were reached by phone and 486 responded to an online survey between May 1-15, 2014.
Results show some significant and concerning gaps between what Canadians expect and current realities. While we continue to study the results in detail, we wanted to share some key highlights.
Three Major Gaps to Close:
1. Wait Times from Consultation to Starting Cancer Medications
When asked: “how long do you think would be a reasonable length of time to wait until you start your medication”, the vast majority of respondents (n=1485) wanted and expected to start quickly:
- 69% said less than one week
- 23% said 1-2 weeks
In total, 92% of respondents believe a reasonable wait time would be less than two weeks.
The reality? Two weeks is in fact the metric that Cancer Care Ontario uses for Intravenous therapy. However, there is no measurement whatsoever of wait times for take-home therapies including oral cancer drugs. The harsh reality is that many patients wait a stressful 6-8 weeks or longer. Take-home therapies in ON and Atlantic Canada require paperwork, many contacts, faxes and phone calls, and delays. Wait times are clearly unacceptable and must be addressed.
In other provinces, the patient moves from the oncologist’s office directly to the hospital pharmacy to pick up their medication. In Manitoba, if a patient is not already enrolled, the “wait time” may extend from 24 hours to 48 hours. In Ontario, 48 hours can become 48 days or more...
2. Cancer Patients and Non-Patients Alike Believe that IV and Take-Home Medications Should be Funded Equally.
Our survey intentionally reached out to 957 people (52%) who did not consider themselves cancer patients, survivors, caregivers, or healthcare professionals to gauge a wider spectrum of public opinion. A full 87% of total respondents (n=1444) believe that IV (intravenous) and Take-Home (oral and injectables) should be funded equally.
As is clearly stated in the Principles of the British Columbia Cancer Agency (BCCA): “The route of administration of the cancer treatment should not be a consideration for a different funding mechanism”.
British Columbia, Alberta, Saskatchewan and Manitoba all fund cancer treatments on their formulary without regard to the formulation of the drug as an IV or oral or injectable.
Why have Ontario and the Atlantic Canadian provinces not kept up with the rest of Canada? More and more cancer treatments will be take-home medications – taking therapy at home will save patients visits to the hospital for IV chemo, save caregivers time off work, and save our healthcare systems money by reducing demand on hospital infusions. It just makes sense.
3. Where You Pick Up Your Cancer Drugs Might Surprise You...
Depending upon where you live in Canada, you might pick up your cancer drug at a cancer centre, a regional hospital, or at a retail pharmacy. We asked the question: “Given the choice of a take-home medication, where would you prefer to have your first prescription of cancer drugs dispensed to you?”
- 58% (893) preferred “at a cancer centre where I receive care”
- 17% (265) preferred “from a pharmacist at a retail pharmacy”
- 15% (226) preferred their cancer drugs shipped directly to their home.
Subsequent renewals showed a more even split of preference (29%/35%/25% respectively). Yet, when asked if they had an important question about a take-home cancer drug, only 7% believed they would get the most accurate information about the drug’s safety at a retail pharmacy1.
In 2012, Ontario spent $26 million dispensing take-home therapies (and supportive care drugs) through retail pharmacies by funding markups (8%) and dispensing fees to retail pharmacies . While convenience is undoubtedly important, especially in rural areas, other provinces have built systems whereby the first dose is dispensed at the cancer centre and follow-up renewals are shipped directly to home. Patients in other provinces tell us that those systems work.
Can we do that here? Our White Paper estimates state that an additional $58-$93 million would be needed to fund ALL of the take-home cancer medications for everyone in Ontario (and proportionally the same for Atlantic provinces). Are patients in those provinces willing to sacrifice convenience and pick them up directly at the cancer centre or regional hospital if those savings could be put back into the cancer system?
Thoughts and comments appreciated!
Thank you to all for providing such great input.
1 CancerCare Ontario: Briefing Note: Reimbursement and Distribution for May 8 2014 Think Tank: Enhancing the Delivery of Take-Home Cancer Therapies in ON.