Cancer is an equal opportunity disease. But the way it’s treated is not — and we’re all paying the price. In February, Benefits Canada’s 2015 Employers Cancer Care Summit brought physicians, employers, insurers, pharmacists and healthcare advocates together in Toronto to hear why there are huge nationwide disparities in the quality of available cancer care and access to new medications, as well as in provincial policies toward funding existing tests and emerging treatments.

Dr. Neil Fleshner

Dr. Neil Fleshner, University of Toronto and University Health Network

PSA controversy

Prostate cancer is the most common male malignancy, but governments—and men themselves — seem to be ignoring it.

“Getting prostate cancer is like getting grey hair and wrinkles,” said Dr. Neil Fleshner, chair of urology at the University of Toronto and chief of urology for the University Health Network. “Eighty percent of men will develop some degree of prostate cancer as they age, and one in four will die from it.”

A simple blood test — the prostatespecific antigen test — can dramatically reduce, through early detection, a man’s chance of dying from the disease. Since the test’s introduction in the early ’90s, there has been a 40% decline in mortality for Canadian men battling the disease.

Read: Support employees affected by cancer

Rocco Rossi

Rocco Rossi, Prostate Cancer Canada

So why, then, did the Canadian Task Force on Preventative Health recently say PSA testing isn’t necessary for men of any age? “I think this is an abomination,” said Fleshner. “These guidelines even recommend against the digital rectum exam — even when a man has symptoms such as difficulty urinating. So [the Task Force] is essentially saying we should let any man destined to die of prostate cancer do so.”

Rocco Rossi, president and CEO of Prostate Cancer Canada, agreed. “This is the same organization that, a couple of years ago, suggested mammograms weren’t necessary for women under the age of 50. Guess what happened? Provincial legislators across the country received visits from our colleagues in the breast cancer movement who told them, in no uncertain terms, that if they defunded mammograms, they did so at their peril.” The pressure worked. Governments across Canada continue to fund mammograms for all women.

So why aren’t men mobilizing in the same way? Why aren’t they outraged that the Ontario and British Columbia governments refuse to fund the PSA test for men without symptoms?

Read: Will cancer screening save your life?

“Because men are their own worst enemies,” said Rossi. “We ignore our health. And if it concerns anything below the waist, if we’re not bragging, we’re not talking about it!”

Both Fleshner and Rossi agreed men are being sent the message that the PSA test is optional. “And when men don’t have to take a test, they won’t,” Rossi said. “Because of that, they are dying and suffering unnecessarily.”

The solution is to raise awareness. While the Movember campaign has been hugely successful in doing that, Rossi wants women and workplaces to be more involved. “Women will ask the tough questions and push their men to take this seriously,” he said. “And employers can help by promoting PSA testing and including it in their workplace health plans.”

Impact of oral cancer drugs

Deborah Maskens

Deborah Maskens, CanCertainty

New take-home oral medications, such as those being developed for prostate cancer and chronic lymphocytic leukemia, are radically changing how cancer is treated. But they’re often extremely expensive, and many Canadians are struggling to pay for them.

Deborah Maskens, co-lead of the CanCertainty Campaign for Universal Coverage of Take-home

Cancer Drugs, explained that while the Canada Health Act provides protection for Canadians who need cancer treatment in a hospital, it doesn’t cover new medications that can be taken at home. British Columbia, Alberta, Saskatchewan and Manitoba have stepped in to provide coverage for these new medications, but Ontario and Atlantic Canada haven’t.

Read: Group calls for equal access to cancer treatment

Paulette Birmingham

Paulette Birmingham, Sudbury Cancer Centre and ODANO

Consequently, many cancer patients in Ontario and Atlantic Canada are tens of thousands of dollars in debt. Maskens herself has taken an oral drug for her own cancer that cost $6,000 a month. “I am grateful I have private insurance,” she said. “It has literally saved my life.”

In May 2014, the Ontario Ministry of Health met with oncologists, policymakers and insurers to discuss the issue. There was a clear consensus that radical change is needed. “Their report is in line with what 35 cancer groups have been saying: that Ontario’s cancer care should be more integrated, more comprehensive and simpler, and therapies should be delivered within a single, person-centred system,” said Maskens. “Now we need action.”

Getting help

Lucy Di Carlo

Lucy Di Carlo, Leukemia and Lymphoma Society of Canada

Some support is available for cancer patients in Ontario. Paulette Birmingham, drug access co-ordinator of the Sudbury Cancer Centre and chair of the Oncology Drug Access Navigators of Ontario, explained how her organization helps cancer patients access the medications and funding they need.

“ODANO is a provincial organization of drug access navigators founded to provide support, advocate for members, educate and share resources,” she said. “But our main objective is to remove the financial burden from the patient so they can concentrate on their health battle.”

Lorna Warwick

Lorna Warwick, CLL-PAG (Patient Advocacy Group)

If a patient has no drug coverage, for example, ODANO will help with an application for the Trillium Drug Program, which supports those who have high prescriptions costs compared with their household income. “Trillium applications can take six weeks and cause delays in treatment,” said Birmingham. “We have the ability to request to have them expedited to within two weeks.”

Read: Patient stories centre stage at cancer summit

ODANO also tracks and renews applications to the Ministry of Health’s Exceptional Access Programs and Health Canada’s Special Access Program; looks for funding through private insurance carriers; takes care of prior authorizations and renewals (required every six to 12 months for many drugs); and enrols patients in pharmaceutical company patient assistance programs when applicable.

Robin Markowitz

Robin Markowitz, Lymphoma Canada

Some patients can receive temporary drug cards through the Community Care Access Centre’s Home Care Program. “Unfortunately, there is great disparity in Ontario,” Birmingham said. “In Sudbury, we don’t seem to have the same access to these temporary prescription cards as other regions, where it seems to be standard care. I don’t understand why there’s a difference.”

All presenters made it clear that while great advances are being made in the early detection and treatment of cancer, great gaps remain across the country in accessibility and funding. In some provinces, cancer patients are waiting too long for responses from private payers and government agencies. Said Maskens, “a life is a life, cancer is cancer, and treatment and its financing should be fair and equitable for all Canadians.”

Living and working with cancer

Some slow-moving cancers provide no outward signs an individual is sick—but that person still needs support from his or her employer. Chronic lymphocytic leukemia, for example, is an incurable bone and blood marrow cancer that usually strikes those middle-aged or older.

“It’s not a typical cancer,” explained Robin Markowitz, CEO of Lymphoma Canada. “That’s because, for the most part, it has few symptoms and usually develops slowly. Many people only find out they have CLL from routine blood tests.”

Some people require treatment immediately, but most are simply monitored through regular blood tests until their condition worsens. “They then receive treatment and can be fine for a year or two, but the cancer comes back and they need another form of treatment,” said Lorna Warwick, a board member of the CLL patient advocacy group. “It’s a continuum. But there are exciting new oral therapies in the pipeline that treat CLL like any chronic disease, such as diabetes.”

How can employers help CLL sufferers? One way is to encourage all employees to get flu shots and to avoid coming into work sick. “CLL patients are severely immunocompromised, so the flu can be fatal,” said Lucy Di Carlo, national manager, patient education and support, with the Leukemia and Lymphoma Society of Canada. “Chronic fatigue is another major issue, so being able to provide help by adjusting shifts or allowing people to work from home can make a huge difference in their ability to remain productive.”

Moira Potter is a freelance writer based in Toronto.

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Copyright © 2017 Transcontinental Media G.P. This article first appeared in Benefits Canada.

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