Understanding access to novel high-cost therapies across Canada: A survey of pediatric oncology providers.
Notice bibliographique
Résumé
e13500 Background: In Canada’s publicly funded healthcare system, access to novel cancer therapies is often inequitable. Despite compelling evidence for therapies including targeted drugs, proton therapy, and cellular therapy, many are high-cost and not publicly funded. Provinces differ in their funding review processes, resulting in variable reimbursement, despite national assessment strategies. To explore disparities in access to these therapies for children with cancer, we created an online survey to examine access to select evidence-informed but not universally funded treatments. Methods: This online vignette-based cross-sectional survey of pediatric oncology providers across 16 Canadian centres explored blinatumomab for low-risk relapse of ALL, larotrectinib for TRK-fused soft tissue sarcoma, proton therapy for unresectable head and neck sarcoma, and CT for first relapse of ALL in a patient with Down Syndrome (DS). The primary outcome was provider-reported accessibility to each therapy, compared across centres. Secondary outcomes included time to accessing therapies, funding source, and perceived barriers to access. Results: 70 respondents participated, with 68 (97%) completing at least one question. Respondents' primary roles were pediatric medical oncologist (45.6%), oncology pharmacist (14.7%), nurse practitioner (10.3%), radiation oncologist (10.3%), and hematopoietic stem cell transplant/CT physician (4.4%). Blinatumomab was accessible for low-risk relapse of ALL over 80% of the time, except in Nova Scotia (75%) and Quebec (70%). Reported access to proton therapy was highly variable, ranging from 33.3% in Nova Scotia to 100% in Manitoba. CT for first relapse in patients with DS was deemed accessible 94% of the time, and larotrectinib was deemed accessible 79% of the time. Barriers to accessing blinatumomab, proton therapy, and CT included prolonged time to obtain therapy, patient/family unwillingness to travel for therapy, and economic and psychosocial impact of travelling for therapy. Additional barriers to accessing proton therapy included challenges managing complex patients through travel, and immigration and visa restrictions. Barriers to accessing larotrectinib included being cost-prohibitive for the treating centre and patient, and other effective therapies being faster to obtain. Conclusions: Our findings demonstrate inequitable access to evidence-informed therapies in Canada. The direct costs of these therapies must be addressed to make them less prohibitive for families; however, strategies must also be developed to mitigate psychosocial and economic impacts of travelling to obtain therapies. Universal funding of these therapies, and simplified access to proton therapy centres, including the development of Canadian proton therapy facilities, would increase equitable access, ultimately improving outcomes for children with cancer.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,004 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».