CAPCA is committed to implementing a sustainable cancer system that provides timely access to high-quality patient-centred care. To do this we are focused on addressing the significant challenges that threaten the sustainability of all provincial health systems today.
CAPCA works to strengthen sustainability in Canada’s cancer care systems. We do that through actions related to:
- advising on drug funding implementation issues;
- developing a collective response to shortages;
- strengthening real-world evidence for new therapies; and
- exploring new models of care.
Supporting Drug System Sustainability
Cancer Drug Funding Sustainability Initiative
CAPCA launched the Cancer Drug Funding Sustainability Initiative in 2016. This Initiative works to evaluate how new drugs can be incorporated into existing treatment protocols, ensuring value for money.
The work of the Initiative is undertaken by a multidisciplinary group, the Cancer Drug Implementation Advisory Committee (CDIAC). Membership includes provincial pharmacy leads, medical oncologists, an ethicist, and patient, family and public representatives. Many of the members of CDIAC also work on the evaluation and assessment of new cancer drugs.
CDIAC provides advice to provincial Ministries of Health and to the pan-Canadian Pharmaceutical Alliance (pCPA).
Achievements of CDIAC:
- greater information sharing about cancer drug implementation issues across the country;
- consistency in messaging about cancer drug implementation issues;
- national understanding of value, affordability and budget impact; and
- sustaining a focus on the role of real-world evidence to inform cancer drug funding and use.
In 2020, key functions of CDIAC were embedded into the existing Pan-Canadian Oncology Drug Review (pCODR) Health Technology Assessment process. CAPCA’s continuing involvement focuses on issues relating to cancer drug funding sustainability through its work with Canadian Agency for Drugs and Technologies in Health (CADTH) and other partners.
Quotes from CDIAC Members
“CDIAC has excelled in harmonization and discussion amongst the provinces.”
“The main accomplishment is having all provinces align on a pathway and way of funding not just new treatments and existing treatments.”
“Before CDIAC, implementation issues were only highlighted after the fact – and only some provinces were consulted.”
“Before CDIAC, recommendations from pCODR would be fed directly into negotiation with little opportunity for cancer programs to consider how to implement these therapies.”
“I see CDIAC as having a positive influence on the ‘postal code lottery’ problem by engaging discussions with and between provinces.”
See also:
Review of Program Development and Implementation (2019)
Supply Disruptions
Drug shortages are a growing concern in Canada, particularly in cancer treatment. Changes to treatment plans can have significant patient care implications.
CAPCA established the Drug Supply Disruptions (DSD) Task Group to assess the severity and acuity of shortages in 2015. This Group:
- shares resupply and access solutions;
- develops recommended mitigation and conservation strategies;
- provides advice to Health Canada about prioritization and supply management in a national cancer drug shortage; and
- has established a Framework with a clear and consistent approach for drug shortages that considers patient and operational impact.
Achievements:
- Facilitate Access – The DSD Task Group has introduced approaches for how to best manage drug access during a shortage.
- Rapid Response – When a cancer drug shortage in a province is identified, the information is shared within 24-48 hours.
- Knowledge Mobilization – Key stakeholders receive information about cancer drug shortages, including how to conserve or source supply.
- Pan-Canadian Alignment – A Pan-Canadian agreement now includes strategies about drug inventory and conservation strategies.
- Advocacy – The DSD Task Group advocates for novel approaches to accessing drugs during a shortage through Health Canada, manufacturers and suppliers.
Marc Geirnaert
Marc Geirnaert, Director, Provincial Oncology Drug Program, CancerCare Manitoba
Marc Geirnaert, Director, Provincial Oncology Drug Program, CancerCare Manitoba
Darryl Boehm
Darryl Boehm, Director, Oncology Pharmacy Services, Saskatchewan Cancer Agency
Darryl Boehm, Director, Oncology Pharmacy Services, Saskatchewan Cancer Agency
Real World Evidence into Drug Funding Evaluation
Understanding how cancer medications impact patients and outcomes in real-world settings can support efforts to get best value for money.
CAPCA works to improve the ability to collect, analyze and apply real-world evidence for drug funding decision-making.
We supported a proof of concept study examining the real-world evidence of established drugs. This study was undertaken in British Columbia, Saskatchewan, and Ontario in 2017. It evaluated how feasible it is to collect and assess real-world evidence. It compared this evidence to projections based on trial data, and to other standard of care treatment options.
CAPCA is continuing to support this work through the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) project.
See also:
Canadian Centre for Applied Research in Cancer Control
Supporting Access to Oncology Biosimilars
Biologics are treatment agents made from a living organism or its products. They may treat some cancers, diabetes, inflammatory bowel disease and rheumatoid arthritis. Compared to conventional pharmaceutical drugs, biologics are:
- more complex; and
- (usually) much more expensive.
A biosimilar biologic is highly similar to a biologic drug that has already been authorized for sale. Biosimilars are approved by Health Canada based on a thorough comparison to the reference biologic drug. They only enter the market after the expiry of the patent of the reference drug. They are generally more affordable than the reference drug. For these reasons – similar effects and lower costs – biosimilars may support overall cancer system sustainability.
CAPCA is committed to supporting provincial drug programs in introducing biosimilars to Canadian patients. We are:
- working with our members and partners to ensure clinicians and patients understand the role of biosimilars in cancer treatment; and
- participating in the pan-Canadian Oncology Biosimilars Initiative.
See also:
Biosimilars (for healthcare providers)
Exploring New Models of Care
- chronic workforce burnout;
- difficulty recruiting and retaining talent;
- lack of alignment between training institutes and population-based needs; and
- inefficient use of highly-specialized providers.
In 2019, CAPCA began working with the Canadian Partnership Against Cancer (CPAC) on these issues. We are working to support cancer programs in improving access and efficiency of care. We are developing a pan-Canadian approach to long-term cancer workforce planning by:
- assessing the availability of human resources and technologies across jurisdictions;
- highlighting potential issues of resource supply and demand; and
- providing guidance on new or existing innovative models of care.