barriers to cancer treatment in canada are leaving patients and doctors struggling for solutions
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for patients with cancer, especially in advanced stages, access to new drugs can potentially prolong their lives. if one drug stops working, they need to be moved to another to see if that keeps their cancer in check, and so on.
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medical oncologist dr. sandeep sehdev left the u.s. to practice in canada because he couldn’t bear his patients being unable to afford cancer treatment. now, he has to tell patients there is a treatment, but they might not be able to access it in canada.
“i’ve been doing oncology for 34 years. i grew up in canada, but i worked in upstate new york near albany for two years because i wanted to do community oncology at the grassroots level with patients and families. and back then, i’m sure in most of canada, the hospitals couldn’t afford to hire oncologists because of the cost of the ct scan.”
sehdev, a leader in breast and skin cancer treatment and assistant professor at the ottawa hospital cancer centre, says his dedication to patients and their families is always at the heart of his work. he is co-founder of the physician alliance for cancer care and treatment canada, an oncologist led advocacy coalition, and scientific advisor for the canadian cancer survivor network. now he’s speaking out to boost awareness for world cancer day on february 4, 2025 about challenges for patients and their doctors.
new treatments avoid or postpone chemo that is hard on patients
patients have benefited from the ever-expanding techniques and therapies in the oncology field. “there have been some amazing breakthroughs that have revolutionized, even doubled how long our patients are living,” he explains, noting the speed of new advances.
“our patients are living better lives and the new treatments are also allowing us to avoid or postpone chemo that would have been harder on them.”
all this equates to improved quality of life for patients who can continue to work at their jobs and spend time with their families. that’s a huge win, he says, but there’s also a lot of moral angst festering among medical providers like himself who know there’s a better treatment that’s not available in canada. sehdev says he has to tell patients that they’re not getting the same leading treatment that patients are receiving south of the border—not because it isn’t safe or effective, but because of the long process in canada for approval and time to market.
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“if there’s something meaningfully better, we always tell people we can talk about how to get it. if it’s affordable or not, we often get it for them on clinical research trials where it’s free or sometimes a manufacturer will charitably give it free for a year to help.”
canada lagging behind countries with universal healthcare
sehdev says we have amazing doctors and healthcare providers who are committed to finding access to therapies despite the constraints of a system that isn’t meeting all their needs. “we’ve been slipping. our resources are constrained by the way canada controls costs by controlling access, like limiting scanners, limiting numbers of doctors. we’re the second from the worst in the oecd [organisation for economic co-operation and development with 38 member countries] for speed of access to new cancer medical breakthroughs like drugs.”
while the american model is very different, canada is lagging far behind european countries that have universal healthcare in place. a november 2024 report from the fraser institute revealed that among 31 high-income universal healthcare countries, canada ranks among the top third of spenders but receives average to poor value in return. in fact, canada has fewer doctors, hospital beds, mris and among longest wait times than other countries with universal healthcare.
for patients with cancer, especially in advanced stages, access to new drugs can potentially prolong their lives. if one drug stops working, they need to be moved to another to see if that keeps their cancer in check, and so on. with more leading drugs available to them, there’s more possibility for longer life. but, when it comes to cancer, days and months count.
‘red tape just takes too long’ in drug approvals in canada
“it’s the time from the evidence of something being valuable and international guidelines saying it should be given, to the public decision to fund it. we almost always get the important things, but it’s usually two years, so many patients in that situation are not getting the benefit,” sehdev says.
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“the reason is not because the drugs are too expensive, the reason is because the red tape just takes too long.”
he cites a recent example of the very real impact this is having on canadians. “right now i have a patient who just was diagnosed with the spread of her cancer. and you know, her insurance would pay [for a new treatment] but there’s no infrastructure to give it, we’re not allowed to give it in the hospital. and the delay to get government approval will be six months i imagine. and then to get the technology, people say it will be six months, and then the funders may take another year-and-a-half.”
and patients are frustrated by the barriers to treatment as well, says glenn hussey, who is chair of the patient advisory council for myeloma canada, an advocacy and patient support group for people with this type of blood cancer.
he also lives with multiple myeloma, a cancer of the blood plasma, so he understands the stress and uncertainty that comes with cancer.
hussey, 70, was diagnosed in 2006 when he was told he had all the markers for the disease and it would likely develop at some point. “i was at the hospital every couple of months doing blood work for monitoring. unfortunately, in 2017, i got a phone call from the hospital that said we need to start treatment right now,” hussey recalls. he had two stem cell transplants back-to-back in 2018 and has been on a cancer maintenance drug ever since, knowing that he’s expected to relapse after four years. then he will be switched to another drug—depending on what is available in canada.
“one of the issues with myeloma is, while there’s no cure, there are a number of treatments available which can extend the patient’s life and well-being. the good part about that is i’m currently on my first line of treatment. so we’ll see what happens.”
hussey is able to travel and enjoy his life in the moment, having shifted his point of view to the short-term. for him and others in a similar situation, beyond a year, “you’re not sure what’s going to happen.”
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his day-to-day is also about managing the side effects of cancer treatment, like problems with digestion that he takes additional drugs to reduce the symptoms. sometimes, even those drugs for side effects are not easy to get.
drug availability for patients turns life ‘topsy turvy’
“if a drug is not available now, your world quickly becomes topsy turvy, even if it’s a support drug,” hussey says. “it becomes a process of trying to adjust and deal with what you’re faced with.”
bottom line, though, shared by most cancer patients, is that once you’re diagnosed, you want one thing: getting the best care as fast as possible.
“once you start looking at potential treatments and you see some things that are available in one country that are working well and you wonder ‘why can’t we have those?’”
like sehdev, hussey is well aware of the timeframe of up to two years for drug approvals in canada, and drug availability in some provinces long before roll-out in other provinces. so, patients 100 km away in a different province are getting newer treatments.
hussey also points to the high cost of cancer for people who live in remote areas and need to travel to a larger centre for treatment. there are accommodation costs, caregiver costs, sometimes home care and special mobility devices to factor in. while the canadian cancer society estimates a $33,000 average lifetime cost to patients, hussey says it’s likely far higher. “most hospitals have a specialist who can help cancer patients in terms of the funding process and all the rest of it because there are issues related to whatever you quality for.”
for sehdev, the problem weighs heavily in a space where he knows change is possible. he’s co-authored a call-to-action published in the peer-reviewed current oncology to address the impact of delays for patient access to oncology drugs on clinical, economic, and quality of life. he’s also worked with a coalition of 25 cancer clinicians across canada, including youth oncology specialists, nurses and physicians to advocate for improving the system.
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“we have to design a system to work simultaneously and not to work by passing the baton to one after the other, each with a six-month leg for the system to let us do our job properly.” the solution needs to be collaborative, looking at the framework of other european countries and not trying to “reinvent the wheel.”
“bureaucrats are paid, of course, to balance the books. their job is the rigor of the process and the quality of the analysis. but someone has to be accountable for the speed to deliver health,” sehdev says.
“processes take so long, nothing in government works fast. murder cases are dismissed because they didn’t get to court fast enough.”
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