Disparity in public funding of therapies for metastatic castrate-resistant prostate cancer across Canadian provinces
INTRODUCTION:Treatment using abiraterone acetate plus prednisone, enzalutamide, cabazitaxel, and radium-223 (Ra-223) improves overall survival (OS) and quality of life for patients with metastatic castrate-resistant prostate cancer (mCRPC). Despite their proven benefits, access to these therapies is...
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ftcdlib:oai:escholarship.org:ark:/13030/qt75t9846t 2023-11-12T04:21:23+01:00 Disparity in public funding of therapies for metastatic castrate-resistant prostate cancer across Canadian provinces Woon, Dixon TS Chandrasekar, Thenappan Aaron, Lorne Basappa, Naveen S Chi, Kim N Conter, Henry J Gotto, Geoffrey Hotte, Sebastien J Malone, Shawn Saad, Fred Shayegan, Bobby Park-Wyllie, Laura Hamilton, Robert J 328 - 336 2018-10-01 application/pdf https://escholarship.org/uc/item/75t9846t unknown eScholarship, University of California qt75t9846t https://escholarship.org/uc/item/75t9846t public Canadian Urological Association Journal, vol 12, iss 8 Biomedical and Clinical Sciences Clinical Sciences Oncology and Carcinogenesis Cancer Prostate Cancer Urologic Diseases Good Health and Well Being Urology & Nephrology article 2018 ftcdlib 2023-10-16T18:05:02Z INTRODUCTION:Treatment using abiraterone acetate plus prednisone, enzalutamide, cabazitaxel, and radium-223 (Ra-223) improves overall survival (OS) and quality of life for patients with metastatic castrate-resistant prostate cancer (mCRPC). Despite their proven benefits, access to these therapies is not equal across Canada. METHODS:We describe provincial differences in access to approved mCRPC therapies. Data sources include the pan-Canadian Oncology Drug Review database, provincial cancer care resources, and correspondence with pharmaceutical companies. RESULTS:Both androgen receptor-axis-targeted therapies (ARATs), abiraterone acetate plus prednisone and enzalutamide, are funded by provinces in the pre-and post-chemotherapy setting, however, sequential ARAT use is not funded. "Sandwich" therapy, where one ARAT is used pre-chemotherapy and a second is used upon progression on chemotherapy, is funded in six provinces: Ontario (ON), Alberta, New Brunswick, Prince Edward Island (PEI), Nova Scotia (NS), and Newfoundland and Labrador. Ra-223 is funded in five provinces: ON, Quebec (QC), British Columbia (BC), Saskatchewan, and Manitoba to varying degrees; ON allows Ra-223 either pre- or post-chemo (not both); QC allows Ra-223 post-chemo unless chemo is not tolerated; BC allows Ra-223 if other life-prolonging mCRPC therapies have been received or ineligible. Cabazitaxel is funded in all provinces post-docetaxel, except QC and PEI. Cabazitaxel is not funded as fist-line treatment for mCPRC or in combination with other agents. In ON, BC, QC, and PEI, cabazitaxel is not funded after progression on an ARAT in the post-chemotherapy setting. CONCLUSIONS:While all provinces have access to docetaxel and ARATs, sandwiching sequential ARATs with docetaxel is funded only in select provinces. Ra-223 and cabazitaxel access is not ubiquitous across Canada. Such inequalities in access to life-prolonging therapies could lead to disparities in survival and quality of life among patients with mCRPC. Further research should quantify ... Article in Journal/Newspaper Newfoundland Prince Edward Island University of California: eScholarship British Columbia ENVELOPE(-125.003,-125.003,54.000,54.000) Canada Newfoundland |
institution |
Open Polar |
collection |
University of California: eScholarship |
op_collection_id |
ftcdlib |
language |
unknown |
topic |
Biomedical and Clinical Sciences Clinical Sciences Oncology and Carcinogenesis Cancer Prostate Cancer Urologic Diseases Good Health and Well Being Urology & Nephrology |
spellingShingle |
Biomedical and Clinical Sciences Clinical Sciences Oncology and Carcinogenesis Cancer Prostate Cancer Urologic Diseases Good Health and Well Being Urology & Nephrology Woon, Dixon TS Chandrasekar, Thenappan Aaron, Lorne Basappa, Naveen S Chi, Kim N Conter, Henry J Gotto, Geoffrey Hotte, Sebastien J Malone, Shawn Saad, Fred Shayegan, Bobby Park-Wyllie, Laura Hamilton, Robert J Disparity in public funding of therapies for metastatic castrate-resistant prostate cancer across Canadian provinces |
topic_facet |
Biomedical and Clinical Sciences Clinical Sciences Oncology and Carcinogenesis Cancer Prostate Cancer Urologic Diseases Good Health and Well Being Urology & Nephrology |
description |
INTRODUCTION:Treatment using abiraterone acetate plus prednisone, enzalutamide, cabazitaxel, and radium-223 (Ra-223) improves overall survival (OS) and quality of life for patients with metastatic castrate-resistant prostate cancer (mCRPC). Despite their proven benefits, access to these therapies is not equal across Canada. METHODS:We describe provincial differences in access to approved mCRPC therapies. Data sources include the pan-Canadian Oncology Drug Review database, provincial cancer care resources, and correspondence with pharmaceutical companies. RESULTS:Both androgen receptor-axis-targeted therapies (ARATs), abiraterone acetate plus prednisone and enzalutamide, are funded by provinces in the pre-and post-chemotherapy setting, however, sequential ARAT use is not funded. "Sandwich" therapy, where one ARAT is used pre-chemotherapy and a second is used upon progression on chemotherapy, is funded in six provinces: Ontario (ON), Alberta, New Brunswick, Prince Edward Island (PEI), Nova Scotia (NS), and Newfoundland and Labrador. Ra-223 is funded in five provinces: ON, Quebec (QC), British Columbia (BC), Saskatchewan, and Manitoba to varying degrees; ON allows Ra-223 either pre- or post-chemo (not both); QC allows Ra-223 post-chemo unless chemo is not tolerated; BC allows Ra-223 if other life-prolonging mCRPC therapies have been received or ineligible. Cabazitaxel is funded in all provinces post-docetaxel, except QC and PEI. Cabazitaxel is not funded as fist-line treatment for mCPRC or in combination with other agents. In ON, BC, QC, and PEI, cabazitaxel is not funded after progression on an ARAT in the post-chemotherapy setting. CONCLUSIONS:While all provinces have access to docetaxel and ARATs, sandwiching sequential ARATs with docetaxel is funded only in select provinces. Ra-223 and cabazitaxel access is not ubiquitous across Canada. Such inequalities in access to life-prolonging therapies could lead to disparities in survival and quality of life among patients with mCRPC. Further research should quantify ... |
format |
Article in Journal/Newspaper |
author |
Woon, Dixon TS Chandrasekar, Thenappan Aaron, Lorne Basappa, Naveen S Chi, Kim N Conter, Henry J Gotto, Geoffrey Hotte, Sebastien J Malone, Shawn Saad, Fred Shayegan, Bobby Park-Wyllie, Laura Hamilton, Robert J |
author_facet |
Woon, Dixon TS Chandrasekar, Thenappan Aaron, Lorne Basappa, Naveen S Chi, Kim N Conter, Henry J Gotto, Geoffrey Hotte, Sebastien J Malone, Shawn Saad, Fred Shayegan, Bobby Park-Wyllie, Laura Hamilton, Robert J |
author_sort |
Woon, Dixon TS |
title |
Disparity in public funding of therapies for metastatic castrate-resistant prostate cancer across Canadian provinces |
title_short |
Disparity in public funding of therapies for metastatic castrate-resistant prostate cancer across Canadian provinces |
title_full |
Disparity in public funding of therapies for metastatic castrate-resistant prostate cancer across Canadian provinces |
title_fullStr |
Disparity in public funding of therapies for metastatic castrate-resistant prostate cancer across Canadian provinces |
title_full_unstemmed |
Disparity in public funding of therapies for metastatic castrate-resistant prostate cancer across Canadian provinces |
title_sort |
disparity in public funding of therapies for metastatic castrate-resistant prostate cancer across canadian provinces |
publisher |
eScholarship, University of California |
publishDate |
2018 |
url |
https://escholarship.org/uc/item/75t9846t |
op_coverage |
328 - 336 |
long_lat |
ENVELOPE(-125.003,-125.003,54.000,54.000) |
geographic |
British Columbia Canada Newfoundland |
geographic_facet |
British Columbia Canada Newfoundland |
genre |
Newfoundland Prince Edward Island |
genre_facet |
Newfoundland Prince Edward Island |
op_source |
Canadian Urological Association Journal, vol 12, iss 8 |
op_relation |
qt75t9846t https://escholarship.org/uc/item/75t9846t |
op_rights |
public |
_version_ |
1782336831590760448 |