Universal equal-access healthcare system? Not exactly!

Commentary, Healthcare & Welfare, Susan Martinuk

There was “nothing new under the sun” last week when Canada’s premiers turned their annual discussion to healthcare. The premiers made the standard pledge to ensure “their residents have access to timely, quality services consistent with Canada’s universal healthcare systems” and the usual request for more cash from the federal government. 

A commitment to upholding the same broken system maintains the ruse that government can provide all healthcare services equally to all Canadians. In short, it cannot. One key example of this is the enormous inequity that cancer patients face in accessing positron emission tomography (PET) imaging.

PET is the best technology available to identify and diagnose tumours as malignant, determine the extent of spreading, monitor treatment effectiveness, and detect recurrence. These properties make PET a key part of the gold standard for cancer care in almost every developed nation except … Canada.  

The one exception is the province of Quebec, which is home to 40 percent (18) of Canada’s 45 PET scanners).  

Quebec’s PET scanners have been established in a coordinated network and the standard protocol for someone suspected of having cancer is to first undergo a PET scan. Doctors there say it gives them vital information they need to move forward to treatment.

In all other provinces, the first diagnostic step is to undergo a CT (computed tomography) or MRI (magnetic resonance imaging) scan. These older technologies can detect anatomical changes in the body, such as a tumour. But PET’s unique power lies in its ability to visualize the biological activity of cancer cells before they develop into a mass and this enables it to detect cancer at a much earlier stage. As cancer care advocates continue to remind us, early detection results in more timely treatment and greater hope for a positive outcome.

The primary argument against PET is that the technology is expensive (about $3-4 M). But it is short-sighted to look only at the capital costs because there are potential costs-savings at various points in both the diagnosis and treatment phases of cancer protocols.

For example, PET provides real-time monitoring of cancer treatments, allowing doctors to immediately stop the administration of ineffective treatments and perhaps initiate another therapy option. Other studies have shown that the information gained from a PET scan can eliminate the need for further testing and procedures in up to 90 percent of cases, and for a surgical biopsy in 70 percent of cases. Extensive and large volume studies have also consistently demonstrated that PET imaging changes the patient management plan in anywhere from 36.5 to 50 percent of cases for most cancers.  

Some of these changes can be attributed to the PET scan showing that the cancer is more extensive than initially thought and patients making the quality of life choice to decline treatment. Doctors also initiate changes in treatment protocols once they have gained greater information about the cancer from a PET scan. Since information acquired through PET triggers a change in treatment plan in at least one-third of cases, it suggests that doctors who don’t utilize PET imaging prior to treatment may be selecting a suboptimal, or wrong, treatment path for the patient.   

These statistics raise two issues. Firstly, eliminating surgical biopsies, other diagnostic tests, ending futile treatments before the end of a trial and allowing patients to make an informed decision to decline treatment are all cost-saving measures that need to be considered. Any of these scenarios also provides a direct benefit to the patient by preserving his/her limited physiological resources from the rigours and side-effects associated with undergoing surgery, repeated testing or an unsuccessful chemotherapy trial.  

The second issue deserves sober consideration from both cancer patients and healthcare planners. If PET is the standard of care in Quebec (and around the world), then one can rightly assume that cancer patients in Quebec are getting a very different – and better – standard of cancer care than the rest of Canadians. 

Outside of Quebec, it is almost as if PET does not exist. Most physicians rely on CT and MRI as their diagnostic tools because they have always utilized them. Others have limited (or no) knowledge of the value of PET imaging in cancer care. Worst of all, there are some doctors who want to utilize PET but their patients either cannot access it or access it in a timely manner. Ontario has 15 PET scanners that are vastly underutilized for clinical work because of the overwhelming bureaucracy that exists in requesting a scan.  

So why do our politicians continue to put their faith in a universal, equal-access healthcare system that is anything but? Canadians deserve better!