Abstract
The burden of cancer for Canadian citizens and society is large. New technologies have the potential to increase the use of genetic information in clinical decision-making, furthering prevention, surveillance, and safer, more effective drug therapies for cancer patients. Personalized medicine can have different meanings to different people. The context for personalized medicine in the present paper is genetic testing, which offers the promise of refining treatment decisions for those diagnosed with chronic and life-threatening illnesses. Personalized medicine and genetic characterization of tumours can also give direction to the development of novel drugs. Genetic testing will increasingly become an essential part of clinical decision-making. In Canada, provinces are responsible for health care, and most have unique policies and programs in place to address cancer control. The result is inconsistency in access to and delivery of therapies and other interventions, beyond the differences expected because of demographic factors and clinical education. Inconsistencies arising from differences in resources, policy, and application of evidence-informed personalized cancer medicine exacerbate patient access to appropriate testing and quality care. Geographic variations in cancer incidence and mortality rates in Canada-with the Atlantic provinces and Quebec having higher rates, and British Columbia having the lowest rates-are well documented. Our purpose here is to provide an understanding of current and future applications of personalized medicine in oncology, to highlight the benefits of personalized medicine for patients, and to describe issues and opportunities for improvement in the coordination of personalized medicine in Canada. Efficient and more rapid adoption of personalized medicine in oncology in Canada could help overcome those issues and improve cancer prevention and care. That task might benefit from the creation of a National Genetics Advisory Panel that would review research and provide recommendations on tests for funding or reimbursement, guidelines, service delivery models, laboratory quality assurance, education, and communication. More has to be known about the current state of personalized cancer medicine in Canada, and strategies have to be developed to inform and improve understanding and appropriate coordination and delivery. Our hope is that the perspectives emphasized in this paper will stimulate discussion and further research to create a more informed response.
Highlights
Cancer has profound effects on individuals and society
Genetic testing will increasingly become an essential part of clinical decision-making and, as such, will require appropriate coordination for effective adoption and delivery
Because funding or reimbursement for genetic testing is a critical challenge in Canada, the oversight committee would be responsible for recommending the tests that provinces should fund, including developing an appropriate cost model for each test as a benchmark for provinces to measure against their own implementation of the test
Summary
Cancer has profound effects on individuals and society. According to recent estimates, 187,600 new cases of cancer and 75,500 cancer deaths occurred in Canada in 20131. Current data are not available, the economic burden of cancer in 1998 was estimated to be $14.2 billion in health care services and lost productivity[2], a number that is certainly significantly higher today. Treatment based on organ of origin (breast, prostate, colon) will remain important for the foreseeable future, the genetic profile of a tumour and its microenvironment—for example, positivity for human epidermal growth factor receptor-2 (her2), C-kit, or epidermal growth factor receptor (egfr); negative for Kirsten rat sarcoma viral oncogene (KRAS), and so on—will refine disease prognosis in some cases and, more importantly, determine which treatments might be available, with predictive potential, to specific patients. Electronic tools at the point of care will help guide which tests can be ordered, will provide timely results and interpretation, and will provide information for patients and physicians to facilitate decision-making. By identifying genetic changes in carriers, the risk of developing colon cancer can be assessed, and appropriate monitoring can be implemented
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