Ill-funded public good

TheGlobeandMail.com – Opinions/Editorial – Canada risks losing its status as an important centre for clinical trials, and patients could end up receiving well intentioned, but lesser care
Published on Wednesday, Feb. 10, 2010.  Last updated on Thursday, Feb. 11, 2010.

A crisis is quietly unfolding in Canadian hospitals. Clinical trials are being cut short or not started at all. If it continues, it will spell fewer advances in treatment and potentially fewer savings to the health-care system.

Case in point: A study co-ordinated by Mark Levine, chair of McMaster University’s oncology department, is looking at whether one week of radiation treatment after breast-conserving surgery is just as effective at preventing cancer recurrence as 16 days.

If the answer to the trial is “yes,” it means patients would complete treatment far sooner. There is also the added bonus of being able to treat more women with the same resources: a fiscal coup.

But the Tom Baker Cancer Centre in Calgary decided this was an answer they could not afford to find out; it stopped enrolling women in the trial in December, for lack of enough grant money, though it now plans to reopen the trial in the spring. Breast-cancer patients who live in Edmonton, however, can continue to enroll in it, as can patients in more than 20 sites across Canada.

The fiscal pinch is being felt by many clinical trial departments in Canada, particularly those doing cancer research. And no wonder; the cost to put a patient in a study is as much as $20,000, more than a sixfold jump in the past decade.

Progress in medical science has inadvertently helped create this problem. New treatments and therapies mean that patients, particularly with cancer, are living longer than ever. And that means many years – not months – of follow-up study that includes increasingly expensive tests, such as MRIs, CT scans and the collection of tumour samples.

While hospitals used to absorb the cost for some of those items, a growing number of institutions – faced with their own financial woes – are insisting the trials be self-funded.

The problems are limited to academic physicians; pharmaceutical companies that pay for their own studies are not affected. Yet academic studies ask some of the best questions, because the researchers are simply trying to improve patient care; they are not selling a drug or a surgery or a treatment. Is one drug better than another? What are the long-term effects of a drug? Can a cancer therapy be compressed with the same good outcomes?

In the study Dr. Levine is co-ordinating, for example, an affirmative answer could spell a dramatic shift in cancer treatment.

The problem is not one with an easy fix. Some have called for new funding models, better processes to initiate trials with less administrative burden, and perhaps a shift toward smaller, more sophisticated studies.

At a minimum, an investigation into the problem – and potential solutions – is required. Without that, Canada risks losing its status as an important centre for clinical trials, and patients could end up receiving well intentioned, but lesser care.

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