Cancer patients in Canada - especially those who live in remote areas - need to be given access to their electronic health records to ensure they get the best treatment, say the authors of a new report card on cancer in Canada.
The Cancer Advocacy Coalition of Canada says in its annual report card that patients are not getting enough access to their own medical records.
The CACC conducted a survey of oncology clinics located more than two hours from a regional cancer centre, and found that most aren't using electronic health records to record vital information. Of 11 clinics surveyed across the country, only seven had access to an integrated health record system.
Of those seven, only three allowed clinic staff to make notes on the records.
Such limitations compromise patient care, the authors insist, because oncologists who devised the treatment plans are not able to follow whether treatment is being given properly, or what complications the patient encountered.
"This raises the possibility that patients in these communities may not be getting the full benefits of care in terms of efficacy, safety, and efficiencies received by patients in direct proximity to regional cancer centres," said Dr. William Hryniuk, the lead author of the electronic record study and past chair of CACC.
Cancer management can be complicated because treatment is often delivered by a large number of health care personnel located in different locations, Hryniuk said. There is also the risk of errors, given that toxic chemotherapy must often be delivered in distant communities by non-specialists.
The CCAC, which is a national advocacy organization for cancer patients, recommends that all patients be given access to their own electronic records to make sure proper care is being maintained.
Restrictions on HPV vaccine access
The "Report Card on Cancer in Canada" also found a startling lower rate of HPV vaccinations among several provinces that have the highest incidence of cervical cancer.
It found that Nova Scotia, PEI and Alberta have the highest rates of cervical cancer in Canada, yet only 55 per cent of females eligible for the human papillomavirus (HPV) vaccine are included in those provinces' vaccination programs.
Meanwhile, Quebec offers the most comprehensive immunization program against HPV, with 100 per cent of eligible females included, yet has the lowest cervical cancer rates in the country.
In Quebec, girls in Grade 4 receive two doses of the vaccine and then a third dose in Grade 9. As well, any female under 18 may also receive free vaccine from their doctor.
But in Manitoba, girls don't get the vaccine until Grade 6 and there is no plan to help older girls, who missed the vaccine, to get it for free. In the end, only 32 per cent of the target population of Manitoba girls is getting the vaccine.
"Our research reveals that the vaccination programs bear absolutely no relationship to the risk of cervical cancer in each province," said Rosemary Colucci, lead author of the study.
"Sadly, the differences in provincial programs may eventually result in differences in effective control of cervical cancers."
Increasing costs of cancer drugs
The report's authors also found that funding for cancer medications that are taken orally at home has shifted sharply from public health insurance to private insurers. That's leaving employers to take on a greater burden of the cost. It's also forcing Canadians who don't have full-time jobs or health insurance plans to pay for the medications themselves.
The problem could worsen, as the population ages and the number of cancer patients grows by an expected 55 per cent by 2020. As well, the use of oral cancer drugs is growing.
The study also found that of 43 newer drugs studied, 10 accounted for more than 80 per cent of total spending on all take-at-home drugs.
"Expenditures for oral, take-at-home therapies now represent approximately half of the total for all cancer drugs," said Dr. Kong Khoo, a B.C. medical oncologist and lead author of that study.
For the study, CACC researchers reviewed oral, take-at-home cancer drug expenditures in each province between 2002 and 2007. They found that in western provinces, the proportion of take-at-home cancer drugs paid for by the public system is much higher than by private insurers. This proportion decreases east of Manitoba and is then reversed in the Maritimes.
While both public and private payer costs for take-at-home cancer drugs are increasing, private payer expenditures are increasing at a much faster rate across all provinces, the study found.
The authors say that private and public insurers "have yet to come to grips with what is happening" and co-ordinate their drug coverage plans
The notable exception is Quebec, where supplementary drug insurance is mandatory.
