Health Committee on Feb. 15th, 2024

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Knock on wood....

In fact, I am here because I am a cancer survivor. That's why I'm here. Frankly, so much of the testimony we've heard so far has echoed what I went through as somebody who had colon cancer diagnosed at 45.

For me.... I mean, you talked about early detection and you talked about access and being to able to identify and to treat. I think the entire conversation here is about access. I was very lucky: huge shout-out to my doctor. She believed in me when I told her something was wrong. She got me tested. I got the treatment that I required and am now cancer free.

Dr. Sayani, I listened to you when you talked about access and how that is very different for women in different parts of our country. We don't have national standards, as you mentioned. Rural, indigenous and marginalized groups don't have the same access to cancer care. As recommendations for this committee, Dr. Sayani, what are those pieces that need to be done to do that?

Also, how do we balance the fact that health care is very expensive and we can't have the same health care access in different parts of the country because we simply can't afford to do that? How do we bridge that gap? How do we work with the resources we have to make sure that women across the country have access to health care?

I'll start with you, Dr. Sayani, and then I'll it pass it on to others if that's all right.

[Dr. Ambreen Sayani]

Thank you for that question.

I want to start by acknowledging the incredible frontline workers who are in a crisis. There are many very well-intentioned people who are trying to do their best with limited resources, and they do need support in a variety of ways to build capacity, but I think we can also be creative in terms of how we build on the strengths of our country. Those strengths may differ from region to region.

I am a person who works out of Toronto, where approximately 50% of the population has a first language that is not English or French, 50% of the population was not born in Canada, 20% of the population lives with disabilities and around 15% are living with lower incomes, but there are community-based strengths that we can build on.

We know the community health care centres. They have a wraparound model that doesn't just focus on family physicians. I've heard time and again from patients who say that their family physician is not their point of care. There are other people within the community whom they go to for knowledge, for resources, for information, so let's build out those community champions. Who are they? There was a very successful community ambassador program linked to COVID-19 vaccination. How can we leverage some of those examples? The health care system is already strained. How do we support it to function better, and how do we build capacity around it and in the community so that it is catering to the localized needs of the populations that are being served?

Invest in community health centres. Look at other models of care such as the community ambassador program. Build community champions so that people have alternative ways to access information and care pathways that come straight from the roots of the community into the health care system.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Yes, it's a complicated balance because of course we have to use the strengths of each community, but we want some equality and some equity across those communities.

Dr. Anan, would you have something to add on this?

[Dr. Ghadeer Anan]

I'm glad that Dr. Sayani got to speak first because this was exactly what I was thinking. Again, going back to rural settings, it takes a village to get somebody through a cancer diagnosis and treatment, and that's what I find my patients mostly rely on. It's obviously out of the goodness of peoples' hearts, but we can build on that. We can put in place programs that support people who are willing to offer, say, drives to people who do not have access to a vehicle or cannot afford a vehicle, and compensate them for that, compensate them for their time.

The same thing applies to, say, meals for somebody who's getting treatment and having a program in place to make sure that they have enough nourishment, especially when we're talking about seniors. As we all know, cancer is a diagnosis of the elderly.

I agree with what Dr. Sayani said. We need to think outside the box and build more on the strength that comes from our community.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Dr. Simpson, I'll go to you, but I'd also like to just ask you this really quickly.

We just heard that cancer is a disease of the elderly, but we know as well that there's an increase in the number of diagnoses happening with younger women—women like me, who are getting colon cancer in their forties, not in their eighties. Could you address that as well, please?

[Dr. Andrea Simpson]

Yes. As I mentioned, for endometrial cancer, we are seeing a shift to younger and younger women being diagnosed. Relating back to issues around access, I think access to hormonal treatments that could be preventative, especially in patients you can identify are at risk.... Women with polycystic ovary syndrome, for example, are at a higher risk, and hormonal treatment could help mitigate that. A lot of patients, however, are not able to afford the hormonal treatments if they don't have private insurance.

I think this does call for more public access and funded hormonal treatments in every province.

I think also that there should be more access to weight loss interventions such as clinics that can offer weight loss counselling, medications and, in some cases, bariatric surgery as well.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Simpson.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

I think I'm done my time, but thank you.

[The Chair, Liberal, Sean Casey]

Mrs. Goodridge, please proceed for five minutes.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you, Chair.

Thank you to all of the witnesses for being here. I'm going to start with Dr. Anan.

You specifically touched on the supports in rural areas. You made it very clear. I was born and raised in Fort McMurray. I very much am a rural member of Parliament. Both my parents had to get their cancer treatments five hours away in Edmonton, and I remember how much more complicated it was because you don't do a 10-hour day trip typically. We do, but we're kind of crazy.

I say this because that's the reality for many people living in rural communities. I was just wondering if you could talk about some of the best practices you've seen, whether in the Atlantic region or across the country, to support rural patients who are getting very specialized cancer care in urban centres.

[Dr. Ghadeer Anan]

One of the big things we need to work on is providing free accommodation—free housing. Just as you mentioned, a lot of people can't afford to do that 10-hour round trip. They can't afford to stay overnight to get their five- or six-hour treatment. Having accommodation available, attached or very close to cancer centres or cancer clinics would help mitigate a lot of that, with all the supports that come with it, such as a social worker to help with the financial part, as I mentioned before, and a psychologist to help with that.

I'll give you an example. In the two centres here in New Brunswick that give radiation therapy, they have free hostels where the patient can stay, because radiation can go on for weeks, Monday to Friday. It's a five-minute treatment, but people cannot keep on going back and forth every day, five days a week for five or six weeks, so they are offered free stays during the week, but they're not open on weekends.

The same thing should apply to other treatments—

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you. I appreciate that.

In fact, in Edmonton there is Sorrentino's Compassion House. It's a really cool program. It really does cater to women going through treatment, primarily for breast cancer but also for a variety of different cancers. It's kind of like the Ronald McDonald House, but it's for women. It's such a spectacular place. If anyone hasn't heard of it, I would highly recommend checking it out. They make magic happen.

We were really lucky when my mom was diagnosed. I was still in university, so she came and stayed with me.

To streamline a little bit, Dr. Simpson, you talked about robotic care. Could you perhaps highlight where exactly robotic surgeries are currently being performed in Canada? Do you see any opportunity to expand that?

[Dr. Andrea Simpson]

Thanks for that question.

They are few and far between right now. I believe Alberta was the first province to have access to robotic surgery. It's in B.C. and a few centres in Ontario, and I believe it is starting to expand more across Ontario ever since Ontario Health started to fund robotic surgery.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

That's wonderful.

I saw an article that appeared this week in which you were quoted. It talked about some of the pay discrepancies for women's surgeries versus men's surgeries. Could you perhaps expand on that a little bit? I was hoping you were going to say something about that in your opening statement. I think it would be very valuable to hear about that in the context of this committee.

[Dr. Andrea Simpson]

Unfortunately, there has been a lot of work demonstrating that procedures performed on female patients are not remunerated at the same level as procedures performed on male patients, even for relatively similar procedures.

There are a lot of factors that go into this. One of them is that most gynecologists are women, so as our specialty has become more female-dominated, we have not, unfortunately, been remunerated at the same rate as have male surgeons in other specialties. There is a gender pay gap, and it is affecting the way that care is delivered to women patients.

Thank you for bringing that up. I do think this is a big part of the conversation on women and cancer.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

To make it very clear, would you recommend that we institute more pay equity when it comes to things like this? We are going to be having a report on this at some point, so I would really love to hear what your recommendation would be to solve this problem.

[Dr. Andrea Simpson]

I think, as a starting point, you should look at the procedures in the schedule of benefits across provinces and compare them to comparable procedures on male patients and look at pay equity with respect to those procedures. There is a lot of consistent research now showing that this issue spans provinces. There's an undeniable pay gap at this point, so, yes, I would appreciate that being included in the report as well.

It has to do with remuneration to the surgeons who perform these procedures but also with the way hospitals value which procedures are being performed, so really it's about elevating women's health in that area as well.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Simpson.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you.

[The Chair, Liberal, Sean Casey]

Next we have Ms. Sidhu.

Go ahead, please, for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Before I start with questions for the witnesses, I want to say that we know that this week is sexual health week in Canada. I believe it is appropriate for me to put the following motion on notice:

That the Standing Committee on Health affirm its support for reproductive and sexual health rights across Canada, recognize that the right to safe and legal reproductive and sexual care is a right to health care; condemn any effort to limit or remove sexual and reproductive rights from Canadians; and emphasize the importance of protecting and expanding access to reproductive and sexual health care, including abortions and contraceptives.

Now I want to move to the questions, Mr. Chair. My question is for Dr. Simpson.

Dr. Simpson, you talked about the standard high school programs for awareness so that young girls know that early detection is the key. Also, I want to talk about ovarian cancer and how BRCA1 is helping to detect the next generation and how the mutations change. Perhaps you can answer that.

[Dr. Andrea Simpson]

Thank you very much.

With regard to a national health education program, I believe it was brought up as part of this women's health study relating to endometriosis and pelvic pain. Unfortunately, right now a lot of young girls have either painful, heavy or irregular periods, and they don't realize that it's something that can be treated to improve their quality of life. I think introducing these concepts early is important, especially among young girls who are probably missing out on a lot of days of school every month because of their periods.

With respect to ovarian cancer, I'm not a cancer surgeon and I'm not an oncologist, so I can't answer your question about the BRCA1 mutation. I don't know if one of my co-panellists would like to address that.

[Sonia Sidhu, Liberal, Brampton South, ON]

Dr. Sayani, do you want to chime in about how the BRCA1 mutation is helping to detect the early cancer stages?

[Dr. Ambreen Sayani]

All I can say is that I've looked into the accessibility of genetic testing, and what it really boils down to is the awareness level within communities about the fact that genetic testing exists. To quote a community member, “When I look at ads for genetic testing, I don't see myself represented, so I didn't even know that was applicable to me.”

The awareness doesn't exist within communities. Furthermore, when they do go to access care pathways, those conversations may not be culturally appropriate.

We also need to consider how we can.... It's not just about getting the result but about supporting people if they are positive. What do those care support pathways look like? Those are the pieces of work that I have studied, but I don't study genetic markers. I study access to different care pathways.

[Sonia Sidhu, Liberal, Brampton South, ON]

Dr. Anan, do you want to chime in?