Approximately 225,800 Canadians were diagnosed with cancer in Canada in 2020, and 83,300 died of the disease. Lung, colorectal, breast, and prostate cancer will account for about half of all cancer diagnoses and deaths in 2020. About one in two Canadians will develop cancer in their lifetimes and one in four will die of the disease.1 This life-threatening illness affects entire communities, especially families, friends, and co-workers. In addition to the physical and emotional hardship a cancer diagnosis brings to an individual and the family, a financial burden can devastate patients.
The Canadian Cancer Survivor Network (CCSN) is a national healthcare charity that works to connect patients, survivors and other stakeholder groups with decision-makers and the wider community to engage in discussion and to act on evidence-based best practices to alleviate the medical, emotional, financial, and social costs of cancer.
The Federal government has an important role to play in making sure that Canadians diagnosed with cancer receive more financial support during diagnosis and treatment. We invite you to respond to the following questions related to cancer care and healthcare. Your responses will be circulated to cancer patients and survivors, posted on our website, www.survivornet.ca, disseminated to our 10,000 newsletter subscribers, and on our social media.
Question 1: Cancer Can’t-Wait: COVID-19 disruption of cancer care in Canada
In the past 18 months, the Canadian Cancer Survivor Network has commissioned Leger to conduct three surveys on cancer care in Canada during the pandemic. In addition to the physical impact of COVID-19 on those facing cancer, the disruption of cancer care has taken a considerable mental and emotional toll, with most Canadians surveyed saying that delays in appointments and treatment have had a major impact on their mental and emotional health. Results of the third survey, which took place during the third wave of COVID-19, include:
- Fifty percent of cancer patients and caregivers report that appointments with doctors are still being cancelled, postponed, or rescheduled. On average, it took 28 days to reschedule.
- Six in ten recently diagnosed cancer patients and seven in ten patients with metastatic or stage 4 cancer report having procedures/surgeries cancelled, postponed, or rescheduled. On average, it took 44 days to reschedule these procedures/surgeries, and 33 percent reported that they still don’t have a rescheduled appointment or procedure/surgery time.
- Delays in appointments and treatment have an impact on cancer patients, caregivers, and those in the process of being diagnosed, with 69 percent stating that these delays are having a major impact on their mental and emotional health.
The Canadian Cancer Survivor Network believes many cancer patients will be diagnosed at a later stage that will be more difficult to treat, in some cases leading to unnecessary deaths.2
- Provide transfer payments to the provinces to be used to deal with the backlog of tests, procedures, and surgeries?
- Encourage the governments of provinces and territories to include the continuation of essential cancer care in planning for future crises and pandemics?
- Ensure that the Public Health Agency of Canada takes cancer patients’ need for dependable access to medical care into account in their plans and recommendations for future pandemics?
Question 2: Employment Insurance Sickness Benefits
The Employment Insurance Program in Canada offers temporary financial assistance to unemployed workers. This assistance includes providing sickness benefits to employees unable to work because of sickness, injury, or quarantine and who would otherwise be available to work, with sickness benefits up to a maximum of 15 weeks.More than 350,000 Canadian workers claim sick leave through the EI program every year.3 However, most cancer patients spend more than 15 weeks receiving or recovering from cancer treatment.
A study on EI Sickness Benefits was recently published in the International Journal of Health Policy and Management entitled “My Cancer is Worth Only Fifteen Weeks? A Critical Analysis of the Lived Experiences of Financial Toxicity and Cancer in Canada.”4 The study concluded that cancer patients experience financial hardship due to rising expenses related to cancer treatment and declining income levels associated with reduced employability. Cancer patients need income support programs that are tailored to match their healthcare priorities. In addition, policies which strengthen working conditions and facilitate reintegration to work when possible will be important in addressing the structural drivers of income insecurity experienced by cancer patients.
The estimated cost of raising the number of weeks from 15 to 50 would only raise the EI premium by a total of 6-cents from the baseline rate of $1.62 per $100 of insurable earnings.5
If elected, will your government:
- Recognize that there is a need for a new process that acknowledges that some patients, including cancer patients, experience extended periods of treatment and recovery, and hold open consultations with Canadians about how this process will be developed and implemented?
- Use the results of these consultations to lengthen sickness benefits for Canadians undergoing treatment for cancer as well as other serious illnesses that require long periods of treatment or recovery so that Canadians who are ill are not penalized by the current limit of 15 weeks of sickness benefits?
- Cancel the two-week waiting period for EI Sickness Benefits so that sick Canadians are not penalized?
Question 3: Breast Cancer Screening
The Canadian Task Force on Preventive Health Care’s guidelines on breast cancer screening has a direct impact on eight million Canadian women aged 40-74. These guidelines disregard expert input and place the lives of women in Canada at risk. They ignore the importance of screening women in their 40s, the relative benefits of additional screening, the significant benefits of early cancer detection, the findings of modern relevant data, and the risks of breast density.6 Over 130 breast cancer experts have strongly criticized the guidelines, and over 83,500 people have signed a petition urging the Health Minister to reject them.
If elected, will your government:
- Place a moratorium on the use of the 2018 guidelines and create a new Task Force which incorporates relevant expert opinion?
- Ensure that the flawed process and lack of accountability of the Task Force be reviewed and revised to align with international guidelines and methodology standards?
- Ensure that future guideline panels include content experts and patients?
- Create a new Task Force which accurately incorporates relevant expert opinion?
We thank you for your attention to these important matters.
President and Chief Executive Officer
Canadian Cancer Survivor Network
- Projected estimates of cancer in Canada in 2020, https://www.cmaj.ca/content/192/9/E199
- Doctors warm of late diagnosis as cancer screening backlog grows, CMAJ, May 31, 2021. https://www.cmaj.ca/content/193/22/E811 . Cancer that went undetected during the pandemic an ‘impending disaster,’ specialists warn, CBC https://www.cbc.ca/news/canada/montreal/cancer-diagnosis-backlog-covid-19-quebec-1.5896297 Bigger tumours, delayed diagnosis as cancer patients str5uggle amid pandemic, https://www.cbc.ca/news/canada/toronto/covid-cancer-invasive-surgery-1.6142481
- Hadrian Mertins-Kirkwood. On the Mend: The costs and benefits of an extension to the maximum duration of employment insurance sickness benefits, Canadian Centre for Policy Alternatives. https://www.policyalternatives.ca/publications/reports/mend
- “My Cancer is Worth Only Fifteen Weeks?” A Critical Analysis of the Lived Experiences of Financial Toxicity and Cancer in Canada.”International Journal of Health Policy and Management, https://www.ijhpm.com/article_4095.html
- Cost Estimate of an Increase in the Duration of Employment Insurance (EI) Sickness Benefits, Office of the Parliamentary Budget Officer, Ottawa, Canada, April 4, 2019. https://www.pbo-dpb.gc.ca/en/blog/news/EI_Sickness_Benefits
- Patel, S. Estimated mortality of breast cancer patients based on stage at diagnosis and national screening guideline categorization. doi: 10.1016/j.jacr.2018.04.010; Weigert, JM. The Connecticut experiment; the third installment: 4 years of screening women with dense breasts with bilateral ultrasound. doi: 10.1111/tbj.12678 ; Ahn, S et al. Impact of Screening Mammography on Treatment in Women Diagnosed with Breast Cancer. doi: 10.1245/s10434-018-6646-8; Coldman, A, et al. Pan-Canadian study of mammography screening and mortality from breast cancer. doi: 10.1093/jnci/dju261; Tabár, L, et al. The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening. doi: 10.1002/cncr.31840