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Lambert LK, Horrill TC, Beck SM, Bourgeois A, Browne AJ, Cheng S, Howard AF, Kaur J, McKenzie M, Stajduhar KI, Thorne S. Health and healthcare equity within the Canadian cancer care sector: a rapid scoping review. Int J Equity Health 2023; 22:20. [PMID: 36709295 PMCID: PMC9883825 DOI: 10.1186/s12939-023-01829-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/11/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Despite a publicly-funded healthcare system, alarming cancer-related health and healthcare inequities persist in Canada. However, it remains unclear how equity is being understood and taken up within the Canadian cancer context. Our objective was to identify how health and healthcare equity are being discussed as goals or aims within the cancer care sector in Canada. METHODS A rapid scoping review was conducted; five biomedical databases, 30 multidisciplinary websites, and Google were searched. We included English-language documents published between 2008 and 2021 that discussed health or healthcare equity in the Canadian cancer context. RESULTS Of 3860 identified documents, 83 were included for full-text analysis. The prevalence of published and grey equity-oriented literature has increased over time (2008-2014 [n = 20]; 2015-2021 [n = 62]). Only 25% of documents (n = 21) included a definition of health equity. Concepts such as inequity, inequality and disparity were frequently used interchangeably, resulting in conceptual muddling. Only 43% of documents (n = 36) included an explicit health equity goal. Although a suite of actions were described across the cancer control continuum to address equity goals, most were framed as recommendations rather than direct interventions. CONCLUSION Health and healthcare equity is a growing priority in the cancer care sector; however, conceptual clarity is needed to guide the development of robust equity goals, and the development of sustainable, measurable actions that redress inequities across the cancer control continuum. If we are to advance health and healthcare equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.
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Affiliation(s)
- Leah K. Lambert
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Tara C. Horrill
- grid.21613.370000 0004 1936 9609College of Nursing, University of Manitoba, Winnipeg, Canada
| | - Scott M. Beck
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada
| | - Amber Bourgeois
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, Canada
| | - Annette J. Browne
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - A. Fuchsia Howard
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Jagbir Kaur
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Michael McKenzie
- Radiation Therapy Program, BC Cancer, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, Canada
| | - Kelli I. Stajduhar
- grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, Canada
| | - Sally Thorne
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
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Qureshi S, Boily G, Boulanger J, Golo KT, Guédon AC, Lehuédé C, Roussafi F, Truchon C, Strumpf E. Advanced Lung Cancer Patients' Use of EGFR Tyrosine Kinase Inhibitors and Overall Survival: Real-World Evidence from Quebec, Canada. Curr Oncol 2022; 29:8043-8073. [PMID: 36354696 PMCID: PMC9689227 DOI: 10.3390/curroncol29110636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
EGFR tyrosine kinase inhibitors (EGFR-TKIs) are breakthrough palliative treatments for advanced lung cancer patients with tumors harboring mutations in the EGFR gene. Using healthcare administrative data, three cohorts were created to describe the use of three EGFR-TKIs that are publicly funded in Quebec for specific indications (i.e., 1st-line gefitinib, 1st-line afatinib, and post-EGFR-TKI osimertinib). The main objective was to compare overall survival (OS) among patients receiving these treatments to those in previous experimental and real-world studies. The patients who received EGFR-TKIs for indications of interest between 1 April 2001, and 31 March 2019 (or 31 March 2020, for post-EGFR-TKI osimertinib) were included to estimate the Kaplan-Meier-based median OS for each cohort. An extensive literature search was conducted to include comparable studies. For the gefitinib 1st-line (n = 457), the afatinib 1st-line (n = 80), and the post-EGFR-TKI osimertinib (n = 119) cohorts, we found a median OS (in months) of 18.9 (95%CI: 16.3-21.9), 26.6 (95%CI: 13.7-NE) and 19.9 (95%CI: 17.4-NE), respectively. Out of the 20 studies that we retained from the literature review and where comparisons were feasible, 17 (85%) had similar OS results, which further confirms the value of these breakthrough therapies in real-world clinical practice.
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Affiliation(s)
- Samia Qureshi
- Department of Epidemiology, Biostatistics and Occupational Health (EBOH), McGill University, Montreal, QC H3A 1G1, Canada
- Correspondence: (S.Q.); (G.B.)
| | - Gino Boily
- Institut national d’excellence en santé et services sociaux (INESSS), Montreal, QC H3A 2S9, Canada
- Correspondence: (S.Q.); (G.B.)
| | - Jim Boulanger
- Institut national d’excellence en santé et services sociaux (INESSS), Quebec City, QC G1V 4M3, Canada
| | - Kossi Thomas Golo
- Institut national d’excellence en santé et services sociaux (INESSS), Montreal, QC H3A 2S9, Canada
| | - Aude-Christine Guédon
- Institut national d’excellence en santé et services sociaux (INESSS), Montreal, QC H3A 2S9, Canada
| | - Camille Lehuédé
- Institut national d’excellence en santé et services sociaux (INESSS), Montreal, QC H3A 2S9, Canada
| | - Ferdaous Roussafi
- Institut national d’excellence en santé et services sociaux (INESSS), Montreal, QC H3A 2S9, Canada
| | - Catherine Truchon
- Institut national d’excellence en santé et services sociaux (INESSS), Quebec City, QC G1V 4M3, Canada
| | - Erin Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health (EBOH), McGill University, Montreal, QC H3A 1G1, Canada
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Chahal M, Hayden A, Savage KJ, Villa D, Scott DW, Gerrie AS, Lo A, Chan M, Pickles T, Connors JM, Sehn LH, Freeman CL. Outcomes after initial refusal of curative treatment in patients with classic Hodgkin lymphoma. Leuk Lymphoma 2022; 63:2739-2742. [DOI: 10.1080/10428194.2022.2087071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Manik Chahal
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | | | - Kerry J. Savage
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | - Diego Villa
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | - David W. Scott
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | - Andrea Lo
- Division of Radiation Oncology, BC Cancer, Vancouver, Canada
| | - Matthew Chan
- Division of Radiation Oncology, BC Cancer, Vancouver, Canada
| | - Tom Pickles
- Division of Radiation Oncology, BC Cancer, Vancouver, Canada
| | - Joseph M. Connors
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | - Laurie Helen Sehn
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | - Ciara L. Freeman
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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MacPhail C, Snow S. Not All Canadian Cancer Patients Are Equal—Disparities in Public Cancer Drug Funding across Canada. Curr Oncol 2022; 29:2064-2072. [PMID: 35323366 PMCID: PMC8947051 DOI: 10.3390/curroncol29030166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Canada lacks a national drug insurance plan. The home province or territory of a patient determines which cancer drugs are available on the public formulary, who is eligible for public coverage and what portion of the financial burden of cancer care falls to the individual. This narrative review describes the current interprovincial disparities in access to cancer drugs across Canada. Health technology assessment (HTA) of drugs at a provincial and territory level is a closed process, does not necessarily follow the recommendations of national HTA and leads to further delays in drug access. The public coverage of take-home cancer drugs (THCDs) in Ontario and the Atlantic provinces is often fragmented, unnecessarily complex and a barrier to cancer drug access. Policy solutions to address inter-provincial formulary variation and poor access to THCDs are discussed.
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Leong C, Czaykowski P, Geirnaert M, Katz A, Dragan R, Yogendran M, Raymond C. Outpatient oral anticancer agent utilization and costs in Manitoba from 2003 to 2016: a population-based study. Canadian Journal of Public Health 2021; 112:530-540. [PMID: 33471346 DOI: 10.17269/s41997-020-00464-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 12/03/2020] [Indexed: 11/17/2022]
Abstract
INTERVENTION In April 2012, the Manitoba Home Cancer Drug Program (HCDP) was introduced to allow 100% coverage for eligible oral anticancer agents (OAA) and supportive medications for Manitobans with cancer requiring these therapies. RESEARCH QUESTIONS What is the extent of use and cost of OAAs among outpatients in Manitoba from 2003/04 to 2015/16? Did the HCDP change OAA user and prescription patterns? METHODS This was a retrospective, population-based study using administrative data to measure the prevalence of drug utilization over time and the impact of HCDP on OAA use and prescriptions using generalized linear models. Manitobans with cancer who filled an OAA or supportive medication covered by HCDP from 2003/04 to 2015/16 were included. RESULTS This study included 22,393 people with cancer who filled an OAA prescription. The prevalence of OAA use increased from 222 per 100,000 to 328 per 100,000 from 2003/04 to 2015/16. Hormone therapy for breast cancer was the most common class of OAA used (increased from 154 per 100,000 to 231 per 100,000). We observed a 2.6-fold decrease in the prevalence of oral alkylating agents and a 10.7-fold increase in the prevalence of protein kinase inhibitors during the study period. The total cost of targeted OAAs per year for all Manitobans with cancer increased from $1.8 million to $19 million. CONCLUSION We observed an increase in OAA prevalence and the cost of oral targeted chemotherapy is high. Our findings underline the need for addressing these high-cost medications in future developments of a national drug program.
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Affiliation(s)
- Christine Leong
- College of Pharmacy, University of Manitoba, 219 Apotex Centre, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.
| | - Piotr Czaykowski
- CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Internal Medicine, Section of Haematology/Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Alan Katz
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | | | - Colette Raymond
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
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