Ruth Tremblay of Vancouver says she's now "cancer free" because the drug is part of her treatment.
Halifax resident Judee Young wonders if her life will be cut short because her provincial government has declared the same medicine, at roughly $35,000 a year, too expensive to provide.
Young, 47, the married mother of an eight-year-old, calls the contrasts "crazy."
"It's a question of whether my health is not as important as someone else's health. I've been a taxpayer for 25 years and the time comes I need help from my government, and I can't get it."
Tremblay, 48, married and living on a yacht with four step children, said she always thought there was an equality of health care in Canada.
"What I've discovered is it's divided down by province on who gets what."
Avastin, part of a new wave of expensive cancer drugs that works with other chemotherapy to target colorectal cancer cells, has become a lightning rod for a debate over equity in Canada's struggling medicare system.
Those in favour of funding Avastin say denying some patients shows Canada's health system favours the wealthy, or those who are living in a particular province.
However, some who've studied the cost-benefits of drugs say that Avastin, which can't cure cancer but can extend life, isn't a good investment for Canada's third most common form of cancer.
The result to date has been the emergence of a patchwork of decisions across the country, and a battle between patients and the special committees that quietly review drug approvals.
Ontario, Alberta, Saskatchewan, the territorial governments, Manitoba, New Brunswick, Nova Scotia and Prince Edward Island have ruled against paying for Avastin for the time being.
Meanwhile, British Columbia and a single hospital in Montreal, the Jewish General, are providing the treatment as part of chemotherapy.
The Eastern Health District in St. John's, N.L., has also spent $1 million to buy the drug for patients since the province approved the drug in July.
Dr. Michael Moore, who specializes in colorectal cancers at Princess Margaret Hospital in Toronto, said the science is clear that the medicine is effective in extending life for such patients.
"Several studies have shown that people who receive Avastin with their chemotherapy live longer than people who don't receive it," he noted.
A three-year-old study done in the United States tracking a group of 60-year-old plus patients showed that about half had survival rates over five months when given the drug.
However, in Judee Young's case such evidence has only fuelled what has become a protracted debate over cost-benefits for Nova Scotia's Health Department.
The province's Cancer Systemic Therapy Policy Committee twice recommended Avastin be funded, only to have a third review reject it.
The drug is now being reviewed a fourth time on the advice of doctors, in light of fresh medical evidence provided by patient Jim Connors, an executive who pays for his own treatment at a private clinic.
A decision is expected by June 13.
Dr. Andreas Laupacis, a former chair of the Canadian Expert Drug Advisory Committee, said that high drug costs sometimes present a reasonable argument for rejection.
"It's in the realm of being very poor quality for the investment, and so one does need to sometimes make these tough decisions," he said in an interview.
"I'm a strong proponent of using the cost-effectiveness measures to make these decisions, because I can't think of a better way of doing it," said Laupacis, who works at St. Michael's Hospital in Toronto.
"The alternative is to pay for everything and watch our health-care costs and our taxes go up."
However, Barry Stein, president of the Canadian Colorectal Cancer Society, said just looking at figures isn't sufficient.
"This drug provides more additional months of survival than any other drug we have now," he said.
"Of the incremental increases, Avastin has given us more than anything else. If we compare it to childhood leukemia that's how we almost moved to virtual cure, little advance and little advance at a time."
Ultimately, argues Stein, Ottawa may need to step in to provide provinces with special additional funding for such drugs.
"It's unacceptable there isn't equality across the country, and unacceptable patients aren't receiving treatments that are part of the standards of care," he said.
