Ontario spending millions sending cancer patients to U.S. for stem cell transplants, auditor finds

Ontario is spending millions to send patients to the United States for stem cell transplants due to limited capacity for treatment, a problem first identified nearly a decade ago, the province's auditor general said in her annual report tabled Wednesday.

In a close look at health-care spending in the province, Auditor General Bonnie Lysyk also found wait times for some cancer tests and surgeries exceed provincial targets.

The average cost of sending a patient south of the border for a stem cell transplant is $660,000, nearly five times the $128,000 average cost for the procedure in Ontario, Auditor General Bonnie Lysyk said in her report.

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At the time of her audit, the Ministry of Health and Long-Term Care had paid $35 million to U.S. hospitals to treat some 53 patients. That's about $28 million more than it would have cost to treat the patients in Ontario, Lysyk said.

And those costs are projected to go up.

According to the audit, current projections call for 106 Ontarians to have to travel to the U.S. for stem cell transplants between last July and the end of the 2020-21 fiscal year.

Under questioning from reporters, Health Minister Eric Hoskins said the province has spent millions to expand the capacity to treat stem cell transplant patients at facilities such as Toronto's Sunnybrook Health Sciences Centre and Mount Sinai Hospital, as well as locations in London and Hamilton.

The government is working toward a goal of keeping more patients in Ontario, he said.

Lysyk noted that overall, "Ontarians with cancer are generally receiving quality care in a timely manner." But her audit also found gaps in some areas, including wait times for biopsies, some surgeries and tests, including CT scans and MRIs.

According to the report, only 46 per cent of biopsies — which are used to diagnose cancer — performed in hospital operating rooms were done within the Ministry's targeted wait time of 14 days. 

In his remarks to the media Wednesday, Hoskins noted that Ontario has some of the best outcomes for certain cancers in the country, including prostate and colorectal cancers. 

But, he acknowledged, in some areas of care, "there's always more work to be done."

According to the audit:

• Wait times for surgery were longer than provincial targets, and varied regionally. Urgent surgeries for 15 of 17 types of cancer did not meet the 14-day wait-time target set by the Ministry by between one and 35 days. 
• The average wait time at one hospital for urgent breast cancer surgery was 44 days, but at another hospital 15 kilometres away the wait was 14 days.
• Wait times for a CT scan or MRI varied across the province. At one hospital, patients waited up to 49 days for CT scans, while patients waited up to 11 days at a hospital just five kilometres away.

Support services 'inadequate' 

The audit also identified gaps in drug coverage and access to support services and other supplementary treatment for cancer patients.

The full cost of cancer drugs is not covered in Ontario unless the treatment is administered in a hospital, the audit noted. That can leave patients paying hundreds or thousands of dollars out of pocket for oral drugs they take at home. That differs from British Columbia, Alberta, Saskatchewan and Manitoba, which offer patients full coverage of publicly funded cancer drugs for all patients, whether treatment is administered at home or at a facility.

Hoskins made a point of noting that millions of Ontarians are covered for oral cancer drugs under various public programs, including seniors, in whom "the significant majority" of cancer cases occur. Also, more patients will have oral cancer drug coverage when OHIP+, a new provincial pharmacare program for children and youth under age 25 comes into effect on Jan. 1, Hoskins said.

The audit also noted that while Cancer Care Ontario had set a target to use radiation treatment in 48 per cent of cancer cases, in 2015-16 only 39 per cent of cases included radiation treatment.

Support services that would help ease both symptoms and side effects of treatment are also "inadequate," leaving many patients to visit hospital emergency rooms looking for help at least once during the course of their treatment. Meanwhile, access to psychosocial services are "insufficient and vary from hospital to hospital," according to the audit. For instance, in 2016-17, only 5.8 per cent of cancer patients had a consultation with a dietitian. 

Other findings

Meanwhile, the audit looked at other areas of health care in the province and found some gaps in data, as well as opportunities for savings.

For instance, the report noted that the province "may be" spending more than it should on generic prescription drugs. According to the audit, the prices of generic drugs in Ontario dropped significantly over the last decade, but the province still pays more than some countries. For example, Ontario paid 70 per cent more, to the tune of $100 million, than New Zealand for the same drugs in 2015-16.

When it comes to laboratory tests, the province could save millions if it updated the price list it follows to pay private sector labs for their work. Ontario plans to bring in a new list in 2017-18, the audit noted. However, had it been in effect in 2015-16, the Ministry would have saved some $39 million that year.

Hoskins said he began consultations on overhauling lab testing in the province when he became minister in 2015 and legislative and other changes had to be made before the price list could be updated.

"I know we will incur further savings that we can reinvest into the health care system," he said.

Finally, despite spending $1 billion per year on public health initiatives, including about $190 million on chronic-disease prevention, there is no strategy to guide such efforts and no plan to measure their efficacy.

"As a result," Lysyk said, "we don't really know how effective [public health] units have been in this area."