Tuesday, 21 February 2012

Ontario Health Coalition's Summary & Analysis of Ontario's Drummond Report

If you are an Ontario resident, please take a few minutes to read this excellent summary and analysis of the Drummond Report from the Ontario Health Coalition. More information on this Report can be found on the OHC's website at http://www.web.net/ohc/.

February 15, 2012: Much of the preamble to the report and the rhetoric surrounding it aim to create a crisis in spending, even in flagrant disregard for the facts, in order to make the case for cuts.
  • Drummond reports falsely that health spending is growing as a share of the provincial budget.
  • This claim is patently untrue. In fact, health care has been shrinking as a share of the provincial budget.
  • The actual figures from Government of Ontario Annual Budgets show that health care has declined from 47% of the provincial spending on all programs in 2002 to 42% in 2011. (See Ontario Ministry of Finance, Ontario Budgets from 2002 – 2011).
  • Ontario now ranks 8th of 10 provinces in all government spending (including payments on the debt). So we spend at almost the lowest rates in the country, both on a per-person basis and as a percentage of provincial GDP.
  • Ontario also ranks among the bottom of the country on health care funding. Ontario also ranks 8th of 10 provinces in health care spending. Again, this holds true both if measured on a per-person basis and as a percentage of provincial GDP.
  • The measure of sustainability is spending as a proportion of our economic output or provincial GDP. We are significantly below the average for Canadian provinces.

While Drummond focuses on trying to create a crisis around spending which is not supportable by the facts, he never mentions the loss in revenue through tax cuts. This loss now amounts to between $15 and $18 billion per year (more than the entire deficit in one year alone).

Drummond projects pessimistic figures for economic growth and productivity that are less than Ministry of Finance projections. He does not make recommendations to revitalize manufacturing, restore jobs and build economic growth.

Many of Drummond’s recommendations promote health care privatization. Privatization recommendations cover the gamut from home care to hospitals, from LHIN advisory committees to management of complex patients. Recommendations for privatization include for-profit privatization and dismantling of community hospitals. These recommendations pepper Drummond’s report despite government promises that he would not make such recommendations.

The biggest cuts proposed are to hospitals, potentially affecting thousands of hospital beds and a vast range of services. Drummond does not include any measures of need for services or unmet needs in his report. There are a number of contradictory or conflicting recommendations. There are a number of recommendations that would fragment (or dis-integrate) provision of care, despite lots of rhetoric about integration. Drummond does not consider any evidence about for-profit privatization. He recommends more severe curtailment of health care funding than the government has projected to date. There is no costing of his proposals.

Drummond’s Recommendations

Cap health funding at 2.5% annual growth through to 2017 – 18.
This is 1 % or $500 million per year lower than government fiscal projections. It would mean that approximately $4 billion would have to be carved out of health spending increases over the next three years. Most often targeted for cuts in Drummond’s report are hospitals, but he also suggests freezing long-term care beds (though there are 36,000 people on wait lists for long-term care in addition to very significant backlogs for hospital services including acute care services). There are no recommendations to reform home care to provide better, more integrated or public home care.  The money is insufficient to match the lip-service paid to the continuum of care.

Cut hospital services and privatize them, “Divert all patients not requiring acute care from hospitals,” to other places provided by private for-profit or non-profit entities.
Drummond repeatedly calls for for-profit privatization of hospital services and home care, despite his mandate which expressly prohibited recommendations for health care privatization. Drummond has no plan for acute care other than cuts. He thinks that fragmenting hospital care will somehow lead to integration. He seems to not see any role for complex continuing care, rehab, palliative care, outpatient clinics, mental health services, and a whole range of other hospital services. A number of his recommendations would dismantle community hospitals and privatize a significant range of hospital services.

He expressly recommends that all plans for hospital buildings that involve outpatient services be stopped and private operators be contracted for outpatient services.

Put a moratorium on building long-term care homes
Drummond does not include anywhere in his report any assessment of unmet need. There are huge wait lists for long-term care homes (and home care).

Give more power to regional health authorities, including budget powers and powers over a wider range of providers.
Drummond recommends reconstituting the LHINs with more powers and higher CEO salaries, and establishing Advisory Panels for each LHIN hired from the executives of hospitals, long-term care, community care, and physicians (without regard to their for-profit or non-profit/public status). Drummond seems to have no concept of conflict-of-interest among the for-profit providers in particular. Despite lip-service paid to patient-centred care, there is no mention of democracy, nor any consideration of the involvement of patients, public interests and the community in regional health planning. Further, Drummond recommends the government include public health and physicians under the LHINs (no details about this). He recommends the LHINs “steer” patients to different family health teams (no details here either).

Possibly merge or somehow tightly integrate CCACs and LHINs.

Restructure Family Health Teams.
Reduce the number of health care providers by amalgamating more hospitals, creating one entity to represent long-term care homes (for-profit and non-profit/public), amalgamating and closing health service agencies and/or their boards.

Bring in private-sector managers to contain costs for complex patients
Drummond recommends the province involve the private sector in providing advice on complex case management and reducing costs for complex patients. There are some contradictory/conflicting recommendations about this also. In another part of his recommendations, Drummond proposes team-based approaches for complex patients.

Centralize leadership of chronic disease management, particularly for mental health, heart and stroke and renal disease, based on the Cancer Care Ontario model.

More nurse practitioners and physicians assistants, training more nurses and using the health care team to their full scope of practice.

Change funding arrangements.
There are a number of contradictory or at least conflicting recommendations regarding funding. He recommends HBAM (health based allocation model which is global funding) but also fee-for-service hospital funding which is about centralizing care into fewer places and is the opposite of global funding, incentive systems (which up costs if health providers do what the government wants) and also funding that follows patients (no details). These are all different proposals.

Re. physicians’ funding – see the next point. Also, Drummond proposes the LHINs integrate physicians into a rostered system with a blend of salary/capitation(population based) and fee-for-service funding. He repeatedly recommends moving more physicians into family health teams and different funding arrangements.

Move decisions about what is covered under OHIP out of OMA-provincial government negotiations.
Have the Health Quality Council, with the Institute for Clinical Evaluative Sciences (ICES) guide treatment decisions and OHIP coverage.

Include “efficiency” (undefined) in mandate of ICES and the Health Quality Council. Make the test more stringent to limit whether or not a treatment practice or drug is adopted.

Move to fee-for-service funding for more hospital procedures and force hospitals to compete.
Move services out of local hospitals into those that provide volumes for lower prices. Bring in competitive bidding for specialist services. Drummond recommends that “all hospitals” specialize so they would no longer provide a wider range of services. Patients would have to travel from hospital to hospital (or private clinic) to hospital (or private clinic) to access care.  Bring in private hospitals (Drummond calls them clinics.) This is not integration.

Redefine the role of smaller hospitals with large ALC populations.
A number of Drummond’s proposals would dismantle community hospitals and reduce the range of services available. He recommends more amalgamations, moving a vast array of services and beds out to private providers, centralizing care into fewer sites, bringing in private hospitals (he calls them clinics). This is all bad news for rural and smaller towns, but also bad news for larger communities who want to access services in their local hospitals.

Implement David Walker’s recommendations for addressing ALC.
Including measures to provide a continuum of care.

Consider fully uploading public health (the remaining 25% paid for by municipalities) to provincial funding.

Have doctors address diet and exercise before making prescriptions. Promote healthy lifestyles.

Change the Ontario Drug Benefit Program to limit payments for drugs for wealthier seniors, increase co-payments, extend it to lower income people of all ages.

Pursue common drug pricing across Canada to reduce the cost of drugs.
Drummond makes other good recommendations to reduce drug costs, including comparisons between drugs, expansion of generic drugs, making sure the Canada-European Free Trade Agreement (CETA) does not undermine attempts to expand generic substitution.

Centralize all back-office functions.

Bring in electronic health records.

Expand the scope of medicare to cover pharmaceuticals, long-term care and aspects of mental health care.
Drummond suggests either a social insurance model (like Germany) or a public payer model (like Medicare in Canada). There is no money for this given Drummond’s proposed cut to spending targets.

Establish a Commission to guide health reform and consult on the 20-year health plan.

Wednesday, 8 February 2012

Jackie Manthorne's Cancer Blog: Don't miss "The real scandal: science denialism at...

Jackie Manthorne's Cancer Blog: Don't miss "The real scandal: science denialism at...: If you are concerned about breast cancer screening and the over-simplification of breast cancer, you must read The real scandal: science den...

Don't miss "The real scandal: science denialism at Susan G. Komen for the Cure"

If you are concerned about breast cancer screening and the over-simplification of breast cancer, you must read The real scandal: science denialism at Susan G. Komen for the Cure by Christie Aschwanden!

The Susan G. Komen for the Cure has been in the news lately because it cut funding to Planned Parenthood, which, among other services, was providing breast screening for low-income women who couldn't afford it. Then, after a groundswell of protest, Komen reversed its decision. It soon became known that Komen's new VP of Public Policy was a failed Republican candidate for governor of Georgia and that part of her platform had been to de-fund Planned Parenthood.

People are angry, and it's not over yet. But Aschwanden's article explores another aspect of Komen's message to women that is also food for thought north of the border.

Go to http://www.lastwordonnothing.com/2012/02/08/komen/ . I am sure it will reflect the experiences of many involved in the breast cancer community.

Friday, 3 February 2012

World Cancer Day 2012, Part 2

Why does the world recognize a cancer day every year?

Certainly because cancer is still a killing disease in this world.

Personally, as President and CEO of the Canadian Cancer Survivor Network, I recognize cancer is a killer but I will not recognize one world cancer day because cancer patients die every day of the year.
Despite millions upon millions of dollars, there is no cure for cancer. In the north, cancer has become a chronic disease; but not quite. 
Two of my friends died of metastatic cancer in 2011; first world friends, how many of yours have died? Even in the north, cancer is not really a chronic disease. 30% of those of us diagnosed with cancer will eventually be diagnosed metastatic.
And in the south? Most of us are diagnosed Stage 4. 
How brutal, how global!
How unfair.

So let us remember that World Cancer Day is every day.


World Cancer Day 2012, Part 1

World Cancer Day is an annual global day that is recognized every February 4 to raise awareness of cancer.

People, businesses, governments and non-profit organizations work together on World Cancer Day to help the general public learn more about the different types of cancer, how to watch for it, treatments and preventative measures. Various activities and events include:

  • Television, radio, online and newspaper advertisements and articles that focus on the fight against cancer.
  • Nationwide campaigns targeted at parents to help them minimize the risk of cancer within their families.
  • Breakfasts, luncheons or dinners aimed at raising funds for cancer research or projects that help to fight cancer. Many of these events feature keynote speakers or video presentations.
  • Public information booths featuring information kits, fact sheets, booklets, posters and other items that promote the cancer awareness, prevention, risk reduction, and treatment.
Some countries use World Cancer Day to promote campaigns on various cancer issues, such as breast cancer, lung cancer, skin cancer, and cancer in children. Much focus goes towards awareness and risk reduction.
The World Health Organization (WHO), which is the United Nations’ (UN) directing and coordinating health authority, works with organizations such as the International Union Against Cancer (UICC) on this day to promote ways to ease the global burden of cancer. Recurring themes over the years focus on preventing cancer and raising the quality of life for cancer patients.
Let us talk about World Cancer Day and what it means to us. Email me at jackiemanthorne@gmail.com and let me know what you think!

Wednesday, 1 February 2012

Les hommes et les femmes du Québec souffrant de cancer avancé de la prostate ou du sein et présentant des métastases osseuses ont maintenant accès à un nouveau médicament

Le Québec fait preuve de leadership en soutenant les hommes et femmes aux prises avec un cancer avancé de la prostate ou du sein

OTTAWA, le 1er févr. 2012 /CNW/ - Aujourd'hui, le Réseau canadien des survivant-es du cancer (RCSC) tient à féliciter le gouvernement du Québec pour l'accès qu'il offre à un nouveau traitement novateur, XGEVA® (denosumab), visant à prévenir les complications osseuses invalidantes, aussi appelées manifestations osseuses et ce, chez les hommes et les femmes souffrant d'un cancer avancé de la prostate ou du sein s'étant propagé aux os. Le Québec est la première province canadienne à ajouter XGEVA aux régimes publics et privés d'assurance-médicaments.

« Le Réseau canadien des survivant-es du cancer applaudit le gouvernement du Québec qui a rendu XGEVA disponible pour les hommes et les femmes atteints d'un cancer avancé de la prostate ou du sein et présentant des métastases osseuses », affirme Jackie Manthorne, présidente et chef de la direction du RCSC. « Nous prions toutes les provinces de suivre l'exemple du Québec en offrant cet important traitement aux patients qui en ont besoin. »

Le RCSC prête sa voix aux Canadiens souffrant de cancer. Les membres de l'organisation sont d'avis que tous ceux aux prises avec le cancer doivent avoir accès aux nouveaux traitements disponibles et ce, tant à ceux pour le cancer à proprement dit qu'à ceux pour les complications lui étant imputables, notamment les manifestations osseuses. Par ailleurs, son mandat est de s'assurer que l'ensemble de la population canadienne a accès à tous les médicaments approuvés dont elle a besoin pour bénéficier de soins optimaux.
XGEVA se retrouve maintenant dans la catégorie des médicaments d'exception pour la prévention des manifestations osseuses chez les personnes atteintes de cancer de la prostate résistant à la castration et présentant au moins une métastase osseuse. XGEVA agit aussi à l'endroit de la prévention des manifestations osseuses chez les gens atteints de cancer du sein présentant au moins une métastase osseuse et une intolérance au pamidronate.

À propos des métastases osseuses

Les os sont l'un des endroits où les cancers du sein et de la prostate se propagent le plus souvent. En effet, 65 à 75 % des hommes et des femmes souffrant d'un cancer avancé de la prostate ou du sein verront leur maladie se propager à leurs os1.

Une fois que le cancer a atteint les os, plusieurs complications graves appelées manifestations osseuses peuvent survenir. Environ 50 à 70 % des gens atteints d'un cancer et présentant des métastases osseuses subiront des manifestations osseuses invalidantes telles une fracture ou une compression de la moelle épinière, phénomènes qui très souvent requièrent des interventions médicales comme une chirurgie lourde ou une radiothérapie2,3,4,5. Or, de telles complications peuvent avoir un impact considérable sur la qualité de vie des patients et entraîner de la douleur et même l'invalidité. Chez les gens souffrant d'un cancer avancé, les manifestations osseuses sont associées à un accroissement de la maladie pouvant même mener à la mort. De plus, elles peuvent imposer un important fardeau économique au système de soins de santé6.
Présentement, il n'existe aucun traitement pour prévenir ou retarder la propagation du cancer aux os. Toutefois, un traitement pour les complications associées aux métastases osseuses comme XGEVA peut aider à prévenir ou à retarder les fractures, la compression de la moelle épinière ou le recours à la chirurgie ou à la radiothérapie.

À propos du Réseau canadien des survivant-es du cancer

Le Réseau canadien des survivant-es du cancer est un réseau national formé de patients, de familles, de survivants, d'amis, de partenaires communautaires et de commanditaires. Sa mission est de travailler en collaboration afin que les patients et survivants du cancer bénéficient des meilleurs soins ainsi que de soutien, de suivi et d'une meilleure qualité de vie. Le réseau s'emploie à éduquer le public et les décideurs en matière de cancer et à stimuler la recherche qui permettra de découvrir des moyens de soigner cette maladie de façon optimale au Canada. Suivez-nous sur notre blogue http://jackiemanthornescancerblog.blogspot.com/.
1 Coleman RE. Skeletal complications of malignancy. Cancer. 1997; 80(Suppl):1588-94.
2 Coleman RE. Skeletal complications of malignancy. Cancer. 1997;80(Suppl):1588-94.
3 National Cancer Institute. Dictionary of Cancer Terms - spinal cord compression. [http://www.cancer.gov/dictionary]. (Consulté le 31 août 2010).
4 Saad F. Impact of bone metastases on patient's quality of life and importance of treatment. Eur Urol. 2006;5(Suppl):547-550.
5 Janjan NA. Radiation for bone metastases. Cancer. 2000:80:1628-1645.
6 Schulman KL and Kohles J. Economic burden of metastatic bone disease in the U.S. Cancer. 2007: 109(11):2334-2342.

ou pour planifier une entrevue, veuillez contacter :
Jackie Manthorne
Réseau canadien des survivant-es du cancer
613-898-1871 / jmanthorne@telus.blackberry.net

Men and Women with Advanced Prostate or Breast Cancer and Bone Metastases in Quebec Now Have Access to New Medication

Quebec shows leadership in supporting men and women with advanced prostate and breast cancer

OTTAWA, Feb. 1, 2012 /CNW/ - Today the Canadian Cancer Survivor Network (CCSN) congratulates the Quebec government for providing access to an innovative new treatment, Xgeva® (denosumab), for the prevention of debilitating bone complications, known as skeletal-related events (SREs) in men and women with advanced prostate or breast cancer which has spread to the bone. Quebec is the first province in Canada to list Xgeva on public and private drug plans.

"The Canadian Cancer Survivor Network applauds the government of Quebec for making Xgeva available to men and women with advanced breast or prostate cancer and bone metastases," said Jackie Manthorne, President and CEO, CCSN. "We call on each of the provinces to follow in the footsteps of Quebec to make this important treatment available to the patients who need it."

CCSN provides a voice for people affected by cancer. It believes that all Canadians battling all types of cancers must have access to new treatments, both for the cancer itself and complications arising from the cancer, such as SREs. Further, its mandate is to ensure that Canadians have access to all of the approved medications they need for optimal care.

Xgeva is now listed as a médicament d'exception for the prevention of SREs for people with castrate-resistant prostate cancer, presenting at least one bone metastasis; and for the prevention of SREs for people with breast cancer, presenting at least one bone metastasis and who show intolerance to pamidronate.

About bone metastases

One of the most common places for breast and prostate cancer to spread is to the bone. In fact, 65 to of 75 per cent of men and women with advanced prostate or breast cancer will have the cancer spread to their bones.1

Once cancer has spread to the bone, a number of serious complications can occur, known as SREs. Approximately 50 to 70 per cent of all cancer patients with bone metastases will experience debilitating SREs, such as fractures or spinal cord compression, which necessitates procedures like major surgery and radiation.2,3,4,5 Such complications can profoundly impact a patient's quality of life and cause disability and pain. In people with advanced cancer, SREs are associated with increased illness and death, and can place a significant economic burden on the healthcare system.6

While there are currently no treatments to prevent or delay the spread of cancer to the bones, treatments like Xgeva, for the complications of bone metastases, helps prevent or delay broken bones, spinal cord compression, or the need for surgery or radiation from occurring.

About Canadian Cancer Survivor Network (CCSN)

The Canadian Cancer Survivor Network is a national network of patients, families, survivors, friends, families, community partners and sponsors. Its mission is to work together by taking action to promote the very best standard of care, support, follow up and quality of life for patients and survivors. It aims to educate the public and policy makers about cancer and encourage research on ways to alleviate barriers to optimal cancer care in Canada. Follow CCSN via their blog at http://jackiemanthornescancerblog.blogspot.com.
1 Coleman, RE. Skeletal complications of malignancy. Cancer. 1997; 80 (suppl): 1588-1594.

2 Coleman, RE. Skeletal complications of malignancy. Cancer. 1997; 80 (suppl): 1588-1594.
3 Dictionary of Cancer Terms - spinal cord compression. National Cancer Institute website. http://www.cancer.gov/dictionary. Accessed Aug. 31, 2010.
4 Saad F. Impact of bone metastases on patient's quality of life and importance of treatment. Eur Urol. 2006; 5(suppl): 547-550.
5 Janjan NA. Radiation for bone metastases. Cancer. 2000:80:1628-1645.
6 Schulman K and Kohles J. Economic burden of metastatic bone disease in the U.S. Cancer. 2007: 109 (11):2334-2342.

For further information:
or to arrange an interview, please contact:
Jackie Manthorne, President & CEO
Canadian Cancer Survivor Network
613-898-1871 /