How Canada is Making Strides in Canadian Patient Care

By Cindy Manchulenko, Clinical Trials Project Manager Clinical & Systems Transformation, and Board Member of the Myeloma Canada Research Network

Shared decision making is an important topic that is gaining more recognition by healthcare professionals. As patients are increasing their understanding of their disease and treatments, they are becoming more empowered. Those that feel empowered will be more likely to take their health into their own hands, make better lifestyle decisions (exercise and good nutrition) and will be more compliant on very complicated treatment regimens. Empowerment also places the patient as the captain of the team, with their healthcare professionals "on the bench" with them, as opposed to the patient feeling separate from the team, isolated and helpless. In my experience, an empowered patient is a resilient patient, and resilience is key for the turbulent course of the myeloma journey.

Financial toxicity is an interesting topic in Canada. All Canadian patients receive some form of treatment, although it can vary from province to province based on which Health Canada approved agents are publicly reimbursed. The main financial toxicity I see in Canada right now is the rising cost of novel agents and multi-drug treatment regimens. With the healthcare system already in financial crisis, the added cost of pharmaceuticals for all cancers is putting too much strain on the publicly-funded system, and we are now seeing drugs being rejected by the drug review, otherwise known as the Health Technology Assessment (HTA) committees (pCODR or INESSS), based on the efficacy of the drug versus the cost. This was first seen at the end of 2016 with daratumumab (Darzalex®) receiving a negative recommendation from pCODR (it has been re-evaluated since then and has received a positive recommendation), as well as ixazomib (Ninlaro®) which received a negative recommendation this spring. Although carfilzomib (Kyprolis®) received a positive recommendation over one year ago, is still not funded by any of the provinces.

Some solutions to combat financial toxicity:

Involve social workers with all newly diagnosed patients in order to ensure that all available resources are used and re-assessed as needed.
Ask patients upfront what kind of extended insurance they have. Extended benefits will help supplement the costs for certain drugs.
Have a voice at the table that represents Canadian patients. This will be key in all future drug approvals. I am proud of Myeloma Canada for already taking initiative and being the leader in drug advocacy by submitting patient surveys for all drug approvals that go to pCODR and INESSS.

Although these solutions help, they are not sufficient and further strategies are needed. Here is an idea: make research cheaper. This would decrease the costs that pharmaceutical companies need to recuperate. How can we accomplish this? First, use technology, like Webinars, instead of flying people all over the world for meetings. Secondly and most importantly, make it possible for researchers and clinicians to work together on similar projects in order to be more cost-effective. We're making great strides with the Myeloma Canada Research Network. The MCRN has opened up clinical trials from Coast to Coast, enabling Canadians to gain access to clinical trials more locally, thereby decreasing their personal financial toxicity and hopefully offering a treatment option that they likely wouldn’t be able to access for years. Kudos to our Canadian team for making waves in myeloma research on an international scale and proving that when we work together, big things can happen.

For more information on Myeloma Canada and the Myeloma Canada Research Network, visit www.myeloma.ca.