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Medical Forum / Diseases and Disorders / Cancer / May 2004Help Needed in Ontario Canada
Cancer scanning machine in jeopardy For almost three years, doctors unsuccessfully tried to hunt down and destroy the cancer cells in Nathalie Lavoie's thyroid. Thanks to a revolutionary imaging machine at St. Joseph's Health Care, that search ended two weeks ago. "We finally found it. They have been able to pinpoint that it is in a lymph node at this point," Lavoie said yesterday. The discovery means surgeons will be able to operate and remove the cancer that three rounds of radioactive iodine treatments failed to knock out. But Lavoie's success story might not be repeated for others. The Ontario government won't pay for the machine that helped -- a PET/CT scan machine, one of only eight in Canada. "It is extremely embarrassing," said Dr. Jean-Luc Urbain, citywide chief of nuclear medicine and chair of nuclear medicine at the University of Western Ontario. "It is pitiful to have a situation like this, where an instrument has been demonstrated extremely useful throughout the world and patients are being denied access to it." Urbain said the PET/CT scan at St. Joseph's is operating with research dollars channelled to the program by London doctors and the support of the hospital. But that money only allows for six patients a week to be scanned. Without government backing, that will soon end. "I hope to be able to keep going another two or three months," he said. The PET/CT scan machine is a combination of two technologies -- positron emission tomography (PET) and computerized tomography (CT). PET scanning tells the doctor the nature of the tissue in the body, whether it's cancerous or not, while CT scanning shows the anatomy. The success rate in finding cancer with a CT scan alone is 60 to 70 per cent. But when a PET/CT scan is used, the success rate climbs to 85 to 90 per cent, Urbain said. "This is a real revolution in diagnostic imaging," he said. But Cancer Care Ontario, the Ontario government agency responsible for cancer treatment in the province, considers the technology still to be experimental. "There is not a lot of scientific research of how effective PET is in diagnosing cancer," said Karen Ramlall, a spokesperson for the agency. It's also an expensive technology and Cancer Care Ontario has to be satisfied there's solid scientific evidence to justify using it amid rising demands on limited health resources, she said. The agency has ordered clinical trials to evaluate PET/CT scans and results are expected this year, Ramlall said. "It is going backwards in time," said Urbain, who maintains the value of PET scans has been proven in other countries. "The government of Ontario is asking us to reinvent the wheel." Last week, the Alberta government said it would pay for the technology. ---------------------------------------------------------------------------------- Just to let you know. My Wife needs this machine to continue her treatment successfully. So if you all don't mind. I could use some help in e-mailing http://www.cancercare.on.ca/ at publicaffairs@cancercare.on.ca and let them know that we can really use it. It's your RIGHT as a Canadian to have a say in what we do with YOUR tax dollars. We have the right to decide what we want our money spent on, medical equipment and services or Liberal mis-use of funds. Dougie® http://fatehfightclub.tripod.com "Dougie®" wrote: > PET/CT scan machine, one of only eight in Canada. > <snip> [quoted text clipped - 4 lines] > Just to let you know. My Wife needs this machine to continue her > treatment successfully. Hi Dougie, Could you please explain how a PET/CT would be helpful to your wife's condition? For monitoring response of chemo? (and making treatment decisions, changes, stopping, longer)? For monitoring for disease progression (ie spreading)? For treatment - knowing where to point the radiation therapy? OR ? Please/thanks J > Cancer scanning machine in jeopardy > [quoted text clipped - 5 lines] > "We finally found it. They have been able to pinpoint that it is in a > lymph node at this point," Lavoie said yesterday. You shouldn't believe everything you read in the newspapers > > Cancer scanning machine in jeopardy > > [quoted text clipped - 7 lines] > > You shouldn't believe everything you read in the newspapers What's your point, please? This one says PET is important for management/treatment decisions http://www.cbc.ca/stories/2004/04/20/sci-tech/pet_scans040420 "Having the PET scan hasn't saved Srigley's life but it has spared him unnecessary chemotherapy and radiation. Cases like Srigley's show PET scans do change how patients are managed" J > > > Cancer scanning machine in jeopardy > > > [quoted text clipped - 16 lines] > > J PET, like anything else, is a tool which has its uses. However, just like CT and MRI when they were introduced, it is currently in its ridiculously overhyped phase. Things will settle down. > > > > Cancer scanning machine in jeopardy > > > > [quoted text clipped - 20 lines] > and MRI when they were introduced, it is currently in its ridiculously > overhyped phase. Things will settle down. So PET/CT is over-hyped and the hospital in question didn't need it to begin with? J > > > > > Cancer scanning machine in jeopardy > > > > > [quoted text clipped - 24 lines] > with? > J Define "need" I'd love to have a PET scanner in my clinic, but for 99.9% of the patients it isn't an investigation which would affect treatment or outcome. PET scans in BC cost $2600 each, and that money could certainly be better used elsewhere. > > > > > > Cancer scanning machine in jeopardy > > > > > > [quoted text clipped - 35 lines] > in BC cost $2600 each, and that money could certainly be better used > elsewhere. So is Dougie's wife (lymphoma) part of the other .1% ? (I'm talking about PET/CT which Dougie is posting about). He's just posted that it can be important "to detect tumours". Is that machine required to monitor for lymphoma activity to make treatment decisions (changes to treatments or stopping treatments)? J > > > > > > > Cancer scanning machine in jeopardy > > > > > > > [quoted text clipped - 42 lines] > to treatments or stopping treatments)? > J Well, we have the best outcomes in Canada here in BC for lymphoma, and we don't have a PET/CT > "J" <MeanMach@anon.anon> wrote in message. > > [quoted text clipped - 58 lines] > Well, we have the best outcomes in Canada here in BC for lymphoma, and we > don't have a PET/CT Thanks Steph There's a private one in Vancouver and also one in Toronto. (I did not check other Provinces) Apparently as of a year ago, there were 4 in our Province. They were approved on the basis of research and/or clinical trials. There may be one at the local University Hospital. I'd have to call Monday. Or (there may be one or more in Toronto) which isn't that far away if really necessary. The newspaper article that I read said it was needed for 2 patients. Even if they're being used for research, surely they can pay someone overtime to scan 2 patients.... Sending them by ambulance wouldn't cost them very much. None at the local cancer centre, so I would have to agree with you. They're $3 million dollars. I assume that's not counting the staffing and training and/or interest on loans if they cannot pay them upfront. It's my conclusion that this is being hyped in the newspaper in case philanthropists or "old money" decide to donate to help pay for it. They may also be used for certain heart situations? A media person with connections to that newspaper hobnobs with doctors and "old money". He happens to have a heart condition for which he had prompt surgery. As far as I'm concerned, he can go to Toronto, if that's required for him. The above may sound mean spirited to others, but there's (at any given time) between 20,000 and 40,000 persons in that area who don't even have a family physician. I think there's bigger priorities for healthcare dollars. J > > "J" <MeanMach@anon.anon> wrote in message. > > > [quoted text clipped - 82 lines] > physician. I think there's bigger priorities for healthcare dollars. > J The technology is wonderful, I'm not saying we wouldn't like one. I'm not saying that there are not some patients for whom it would be useful. But it's icing, not the cake > "J" <Nomad@invalid.anon> wrote in message > <snipped>I think there's bigger priorities for healthcare dollars. > > The technology is wonderful, I'm not saying we wouldn't like one. I'm not > saying that there are not some patients for whom it would be useful. But > it's icing, not the cake Thanks Steph, So where do the thyroid cancer patients go in BC? Do they have to be sent out of Province for PET/CT, if it would be useful? J > > "J" <Nomad@invalid.anon> wrote in message > > <snipped>I think there's bigger priorities for healthcare dollars. [quoted text clipped - 7 lines] > Do they have to be sent out of Province for PET/CT, if it would be useful? > J No, it's generally not useful. so we don't do it Cancer patients lose scanner access London cancer patients are losing access to a high-tech imaging machine that can pinpoint tumours often missed by older technologies. "They are shutting us down," Dr. Jean-Luc Urbain, citywide head of nuclear medicine, said yesterday. "I feel terrible, just terrible." Urbain had hoped to keep the so-called PET/CT scanner operating at St. Joseph's Health Care for at least three more months after Ontario's cancer agency decided it wouldn't pay the costs of operating the machine, one of only eight in Canada. London doctors were able to obtain limited financing by tapping Health Canada's Special Access Program. That program paid for the radioactive substance injected into patients to allow the scanner to discover tumours. The injections cost $1,100 a patient. But last week, the hospital was told it could no longer use the federal program, Urbain said. That means the PET/CT scanner at St. Joseph's can only be used for research, he said. There had been a three-month waiting list for scans. "This is very frustrating, very frustrating," said Dr. William Pavlosky, who's with St. Joe's department of nuclear medicine. "We know what this technology can do and we are just not allowed to use it," he said. Developed in 1995, the PET/CT is actually a combination of two machines, using positron emission tomography (PET) and computerized tomography (CT). With it, doctors can determine whether a growth actually is cancerous, Pavlosky said. In some cases, the scanner in London has found tumours doctors missed, resulting in treatment changes. "We are finding disease where disease was never suspected," said Pavlosky. It also has pinpointed tumours, leading to life-saving surgery. Cancer Care Ontario has classified the machine as experimental and ordered clinical trials. "There is not a lot of scientific research of how effective PET is in diagnosing cancer," Karen Ramlall, an agency spokesperson, said last week. It's also expensive, and Cancer Care Ontario has to be satisfied there's solid scientific evidence to justify using it, amid rising demands on limited health resources, she said. Urbain labelled the trials "bogus," saying the technology has already been proven in other countries. Dougie® http://fatehfightclub.tripod.com Cancer scanner cuts outrage specialist They mean London patients will have to go to the U.S. for tests -- at greater cost. London cancer patients who live just blocks from one of Canada's best medical imaging machines will have to travel to the U.S. for their tests -- at a much higher cost. If that isn't strange enough, patients from other provinces have come to London to use the so-called PET/CT scanner at St. Joseph's Health Care London. It's a situation that outrages Dr. Al Driedger, a thyroid cancer specialist in London. "I am just so angry," said Driedger, a member of the provincial committee that called for the introduction of PET scanning in Ontario. The PET/CT scanner at St. Joseph's, one of only eight in Canada, is being shut down for regular patient use and will be limited to research use after a one-two punch from the Ontario and federal governments cut funding to operate it. It costs $1,100 to check a patient on the London scanner, but the bill for doing so south of the border will be as high as $5,000 US, Driedger said. A spokesperson for Ontario's Health Ministry said yesterday the province sent 22 patients to the U.S. for scans over a one-year period until the start of February 2004. Adding insult to injury, Driedger recently cared for a patient sent from another province to be scanned -- and that province readily paid for the procedure. "It's OK for me to do a PET scan on a patient from outside Ontario and get paid for it. I can send a patient that lives in Ontario to the United States and have a scan done. But a patient that lives in Ontario can't have a scan done in Ontario," Driedger said, adding the technology is crucial for finding and deciding how to treat some cancers. In the past two weeks, Driedger said he had two patients that blood tests showed had cancer spreading in their bodies. But CT scans, ultrasounds and other methods failed to find the source of the cancer. "I did PET scans on them and in both cases found where the residual cancer is. Both of these patients will now be properly treated," he said. The advantage of PET/CT scanning is it can detect cancerous cells by measuring their energy use. Other technologies rely on finding actual damage to the structure of organs or an enlargement of lymph nodes. The Ontario government announced recently it will conduct clinical trials of PET/CT scans to see if they should be used here. But Driedger said the government was given a report in 1999 documenting that 45,000 Ontario patients a year would benefit from having the scans. "For the last five years, people have been designing trials and as of today not a single patient has been entered into any trial. They have just played me and my colleagues for monkeys," he said of the province. Driedger said he believes the delays are an attempt by the province to save money. "It saddens me to observe this downhill spiral in Canadian health care," he said. Doctors who want to use the technology were dealt another blow last week when Health Canada said it would no longer allow the drugs used in the scanning to be used under its Special Access Program. The drugs already have been approved as safe in the U.S. and Europe, Driedger said. Health Canada is living in a "fictitious dream world" by maintaining the drugs still must be investigated here before they're used, he said. He noted the London cancer centre was going to take part in a study to assess PET scanning in childhood cancers, but the prestigious National Institutes of Health in the U.S. this week advised it would not pay for the study. "It is the opinion that PET is the standard of care for cancer patients and should no longer be funded as research," Driedger said. Dougie® http://fatehfightclub.tripod.com |
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