Decision-Making Processes Regarding Cancer Technologies: A Review (Canada‪)‬

The issue of timely access to high quality cancer care has heightened in Canada, fueled in part by incidence rates reaching levels where cancer now touches, in some way, the lives of most Canadians. (1) Thus, deliberations over how best to maximize the health of cancer patients are often emotionally and politically charged. Two major issues have been highlighted through the media and the political process: (1) timely access to required services (i.e., waiting times for radiation, surgery and specialist consultation), (2) limits placed on equitable access to services such as diagnostic interventions (e.g., MRI and PET) and (3) cancer drug treatments. As cancer agencies across the country look for ways to provide timely access to technologies that deliver high quality care, they do so facing unlimited demands, limited budgets, and intense scrutiny by both those affected and the media. There seems to be a growing lack of public confidence in decisions about which technologies to publicly fund, particularly in the case of promising, often high cost innovations championed by physicians, patients and manufacturers. As a result, policy-makers charged with the task of ensuring prudent and principled use of scarce resources have become demonized, since the essence of priority-setting means that access to some will be denied. It has become increasingly clear that approaches to priority-setting require a blending of two decisional domains: effectiveness and efficiency (the evidence-based paradigm) and equity/fairness (the values/ethics based paradigm). What remains unclear are ways of marrying the two so that coverage decisions may be deemed legitimate and fair by all stakeholders.