Health Committee on Feb. 15th, 2024

[Dr. Ghadeer Anan]

Thank you.

What I can add is that, even when women come to ask for the testing, as I mentioned, my experience here in Atlantic Canada is that there aren't enough genetic counsellors. Even when I send a referral for genetic counselling, the wait-list is about 18 to 24 months.

[Sonia Sidhu, Liberal, Brampton South, ON]

You also talked about the lack of resources in rural areas for rural access. What is your recommendation to this committee?

[Dr. Ghadeer Anan]

There should be funding for more genetic counsellors to represent the increase in population.

Unfortunately, right now the obstacle and the reason for the long wait is that there are not enough genetic counsellors.

[Sonia Sidhu, Liberal, Brampton South, ON]

Do you have any other recommendations, Dr. Simpson?

You gave three very good recommendations. Do you want to talk about that?

What is your recommendation to the committee on how we can get early detection of any cancer? We know that when cancer is in the third or fourth stage, it is hard to manage. Also, can you provide any recommendations on how to manage the psychological effects?

[Dr. Andrea Simpson]

Thank you for that question.

In terms of early diagnosis, I think it's really around access to endometrial biopsy. We need public awareness first. Patients need to know that they should go in and see their health care provider if they are having menstrual abnormalities.

In terms of access to biopsy, it's not a complicated procedure to do in the office, but I do recognize that a lot of primary care providers are not comfortable providing this or experience other financial barriers, perhaps, to providing this test. I think we should examine those barriers to understand how we can make biopsy more available to patients so that they don't necessarily have to wait for a referral to a gynecologist to have the test done.

Rapid access clinics.... We don't have an organized program for getting these patients in quickly to biopsy them and determine if they have endometrial cancer. I think we should look to other cancer types—perhaps breast cancer—and the way that care has been streamlined to allow more rapid access to diagnosis for these patients.

With respect to the psychosocial, psychological aspects of recovery, I do see it a lot in my practice. Patients really do struggle with their diagnosis in the context of its being related to their obesity, because I think that there is a lot of guilt that comes along with this diagnosis and the feeling that they perhaps should have done something to prevent it sooner.

I usually don't address obesity with my patients prior to surgery. We get them treated first, and then a lot of them ask me about it later and ask about access to weight loss resources to prevent other complications of obesity and improve their quality of life overall. Improving access to weight loss treatments would be another area where I think we can do better.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Simpson.

Thank you, Ms. Sidhu.

Ms. Larouche, you have the floor for two and a half minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Mr. Chair.

I'll continue with my questions for each of the witnesses.

Ms. Van Dusen, you talked about cervical cancer. Vaccination is now available. I'm part of that generation that was made aware of the HPV vaccine and was able to benefit from it. The World Health Organization has also called for the global elimination of cervical cancer, in part because we can now prevent it largely through vaccination.

Is Canada on track to meet the targets set by the World Health Organization by 2030?

I already put this question to another panel of witnesses, but I'd like to hear your answer to this question.

[Ciana Van Dusen]

As I mentioned in our remarks, following a 30-year decline in the incidence rate for cervical cancer, that has now increased by 3.7% since 2015.

Cancer of the cervix is now the cancer in females that is increasing at the highest rate, so that's really concerning, especially given that we've acknowledged that it's incredibly preventable for the most part with vaccination and with screening.

That's why we're coming to you today—in the hope that we can increase the ease of transferring our screening from the Pap test to the HPV test and encourage that kids who are eligible in their province receive vaccinations—both boys and girls.

As you said, we've had incredible progress in delivering that up until now, so we need to keep that momentum going so we can reverse this trend.

[Andréanne Larouche, Bloc, Shefford, QC]

As you say, there are Pap tests, but there are also tests that can be done at home, so there are other ways.

All in all, despite the increase in the number of cases, your tone was still very positive in terms of solutions. Although we have some very positive solutions for this type of cancer, what are some of the obstacles we need to overcome so that this number....

You mentioned self-testing, but do you have any other suggestions?

[Ciana Van Dusen]

Right now we're really calling on Health Canada to approve self-testing.

We know there are provinces—B.C. and P.E.I.—that are going forward with or without this approval. However, other provinces and territories have said that this is a barrier to their ability to bring this test home to Canadians, so that is something very tangible that we can do something about today to make it more accessible.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Van Dusen.

Thank you, Ms. Larouche.

Next we'll have Ms. McPherson.

Go ahead, please, for two and a half minutes.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you.

Again, thank you for the testimony you shared with us today.

Obviously, Canada's New Democratic Party is pushing very hard for pharmacare to be part of our medicare program.

As we talk about access and we talk about testing outside of doctors' offices and whatnot, I'm wondering what access to pharmaceuticals is like and how we could improve that. What would that look like for cancer patients?

I'll start with you, Dr. Sayani.

[Dr. Ambreen Sayani]

More and more cancer treatments are being delivered outside the health care setting. When it's within the hospital setting, the medications are covered, but when we have take-home medications, particularly those that are the supportive medications that improve quality of life, those are covered by drug plans or the patient pays out of pocket.

When we look at it through an equity lens, women are less likely to have those health benefit plans, and they're also less likely to have that cash in their pocket. It really is about who is being hurt the most when there isn't a pharmacare policy. It would improve access for all people and improve their ability to be treated for and survive cancer if they didn't have the stress related to access.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

As you mentioned, women are less likely to have those drug plans that would cover those medications, and they're also less likely to have the income. If you layer that onto marginalized women, women in remote northern communities and women who are experiencing poverty, then the numbers would increase.

I notice that you're nodding. Can I ask for your thoughts on that as well?

[Helena Sonea]

Absolutely. We really appreciate the opportunity to talk about this important issue, because there is an incredible opportunity in front of us.

We really want to ensure that any program put forward has safeguards in existing access and that there are no additional administrative barriers that people with cancer and their loved ones face when accessing the very large patchwork that already exists. For us, it is very centred around not increasing that for that threshold.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you.

[The Chair, Liberal, Sean Casey]

Dr. Kitchen, please, you have five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

Thanks to all of you for being here. It's greatly appreciated.

It's interesting, especially with having the Canadian Cancer Society here with us, and with your conversations. I appreciate that. We've talked about swabs and, in particular, the option of self-testing and the challenges you have with swabs and how it's dictated that the swab has to be used by a medical professional, although I guess that can be changed.

If we look back at COVID and when it happened, all of a sudden we were all so short of PPE, swabs, etc. It was a huge challenge. The government stepped up and said they were going to give out a whole bunch of money to a whole bunch of businesses in this country to ramp up what they were doing, to build this and to bring it.... Now, we find out that we're having a lawsuit brought forward where that actually didn't transpire.

On this issue, what I want to touch on is the aspect of that swab. You say that it should be something that Health Canada does. Have you talked with Health Canada on this issue?

[Ciana Van Dusen]

I have not personally had the opportunity. I'm not sure if anyone else at our organization has.

[Helena Sonea]

We are very fortunate to be part of a large community through the Canadian Partnership Against Cancer. They have individual screening network meetings that bring together a variety of government stakeholders and organizations such as ours. It was through these various conversations that it was brought to our attention that this was a gap. We have not specifically addressed this with Health Canada at this point in time, but certainly after today we will be prioritizing it more.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

I would encourage you to do that, because I think it's something that needs to be brought to their attention such that it can be quickly remedied and is providing for those self.... As you said, someone who's vulnerable all of a sudden gets a form and says, “Oh, this has got to be.... Now I'm not going to use it.” It puts fear in those individuals. That adds further to delays and to not getting those self-tests done when they can be done. It's going to protect women by doing that aspect of things. I do encourage that. Perhaps that might be a recommendation that we have as we move forward.

On that aspect of things, as we look at the issue of providing those self-tests, one of the things that I have seen a lot as a practitioner is a lot of fear amongst patients. It's about educating them. How do we educate women for a simple thing—perhaps Dr. Simpson might want to touch on this too—like the issue of robotic surgery? All of a sudden it's all new. People see it on TV and they watch these movies, etc., but they're fearful of it. There are populations that will be. What are your thoughts on that? How do we get that across to people to get that fear out of there?

I'll go with Dr. Simpson first.

[Dr. Andrea Simpson]

Specific to robotic surgery, it's a technology that's widely available in the U.S., but there have been barriers to bringing it to Canada, mainly related to cost. I do think that we need to be somewhat judicious with the use of robotics in Canada. I'm not recommending that it be used for every single patient. I think it's for the patients who would benefit most from it.

I haven't encountered too much in the way of fear related to robotic surgery in my practice when I talk to patients. I do think that it's a a very well-studied technology. It's the limitations that we've had in Canada so far.

I'm not sure if that answers your question.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you. I do appreciate that.

Dr. Anan, I appreciate your comments, especially from a rural point of view. I come from a very rural area. The biggest community in my riding, which is 43,000 square kilometres in size, has basically about 12,000 people. For my constituents, when they're dealing with things.... For females, when they're going to their practitioners, number one, they have practitioners who, while they're educated, are not specialized in that area. It's a huge challenge for them when it gets diagnosed or, as we heard from Dr. Sayani, there might be a patient where the doctor sloughs it off and doesn't pay attention to it or think it's a big deal.

Those challenges are big, not only from a doctor's point of view but also from a rehab point of view, as you've indicated. It's about making certain that you have that rehab physiotherapist that you might need in certain situations or for breast cancer, etc.

If you would, what are your comments?

[The Chair, Liberal, Sean Casey]

Give a brief response, if possible, please.

[Dr. Ghadeer Anan]

Yes, certainly.

The restrictions are not just because a patient is dismissed or whatnot. Sometimes they don't even seek medical advice—especially in rural areas, as mentioned earlier—because they are caregivers, because they cannot afford to, because they need, say, a son or a daughter to take the day off work to take them to see the doctor and then the specialist, and so on and so forth. Unfortunately, there are a lot of financial restrictions, plus, of course, the stigma that comes with it and women being care providers.

I don't know if that's short enough.