Evidence map›Paper›PMID 29688882›Full record

ArticleCanadian Urological Association journal = Journal de l'Association des urologues du Canada2018

Disparity in public funding of therapies for metastatic castrate-resistant prostate cancer across Canadian provinces.

Dixon T S Woon, Thenappan Chandrasekar, Lorne Aaron, Naveen S Basappa, Kim N Chi, Henry J Conter, Geoffrey Gotto, Sebastien J Hotte, Shawn Malone, Fred Saad and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Real-world evaluation of access-driven Canadian treatment sequences in progressive prostate cancer (REACTIVATE).Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2024
    Article
  2. Review
  3. Review
  4. Review
  5. Disparity in public funding of systemic therapy for metastatic renal cell carcinoma in Canada.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2022
    Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Dixon T S WoonPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
Thenappan ChandrasekarPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
Lorne AaronService d-Urologie and Centre de la Prostate, Hôpital Charles LeMoyne, Longueuil, QC, Canada.
Naveen S BasappaSouthern Alberta Institute of Urology, University of Calgary, Calgary AB, Canada.
Kim N ChiBC Cancer Agency, University of British Columbia, Vancouver, BC, Canada.
Henry J ConterWilliam Osler Health System, University of Western Ontario, Brampton, ON, Canada.
Geoffrey GottoSouthern Alberta Institute of Urology, University of Calgary, Calgary AB, Canada.
Sebastien J HotteJuravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.
Shawn MaloneThe Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Fred SaadCentre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada.
Bobby ShayeganJuravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.
Laura Park-WyllieMedical Affairs, Janssen Inc., Toronto, ON, Canada.
Robert J HamiltonPrincess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionTreatment using abiraterone acetate plus prednisone, enzalutamide, cabazitaxel, and radium-223 (Ra-223) improves overall survival (OS) and quality of life for patients with metastatic castrate-resistant prostate cancer (mCRPC). Despite their proven benefits, access to these therapies is not equal across Canada.

methodsWe describe provincial differences in access to approved mCRPC therapies. Data sources include the pan-Canadian Oncology Drug Review database, provincial cancer care resources, and correspondence with pharmaceutical companies.

resultsBoth androgen receptor-axis-targeted therapies (ARATs), abiraterone acetate plus prednisone and enzalutamide, are funded by provinces in the pre-and post-chemotherapy setting, however, sequential ARAT use is not funded. "Sandwich" therapy, where one ARAT is used pre-chemotherapy and a second is used upon progression on chemotherapy, is funded in six provinces: Ontario (ON), Alberta, New Brunswick, Prince Edward Island (PEI), Nova Scotia (NS), and Newfoundland and Labrador. Ra-223 is funded in five provinces: ON, Quebec (QC), British Columbia (BC), Saskatchewan, and Manitoba to varying degrees; ON allows Ra-223 either pre- or post-chemo (not both); QC allows Ra-223 post-chemo unless chemo is not tolerated; BC allows Ra-223 if other life-prolonging mCRPC therapies have been received or ineligible. Cabazitaxel is funded in all provinces post-docetaxel, except QC and PEI. Cabazitaxel is not funded as fist-line treatment for mCPRC or in combination with other agents. In ON, BC, QC, and PEI, cabazitaxel is not funded after progression on an ARAT in the post-chemotherapy setting.

conclusionsWhile all provinces have access to docetaxel and ARATs, sandwiching sequential ARATs with docetaxel is funded only in select provinces. Ra-223 and cabazitaxel access is not ubiquitous across Canada. Such inequalities in access to life-prolonging therapies could lead to disparities in survival and quality of life among patients with mCRPC. Further research should quantify interprovincial variation in outcomes and cost that may result from variable access.

Identifiers

PMID29688882
PMCPMC6192749

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.