Overcoming obstacles in accessing unfunded oral chemotherapy: physician experience and challenges.
OBJECTIVE
Previous studies have shown hematologists and medical oncologists may not accept the financial limits set by governing agencies on patient access to oral chemotherapy. The purpose of this study was to capture the methods physicians used to overcome barriers to accessing chemotherapeutic regimens for their patients.


METHODS
A total of 640 medical oncologists and hematologists across Canada were surveyed using a 13-item Web-based survey tool. The survey was delivered by e-mail with three follow-up reminders. After a response period of 3 months, results were collated and analyzed with descriptive statistics.


RESULTS
Of the 640 invitations, 568 were successfully delivered, and 183 responses were received (response rate, 32.0%). Among respondents, 101 treated solid malignancies (55.2%), 49 treated nonsolid malignancies (26.8%), and 33 treated both (18.0%). To overcome funding barriers, participating oncologists enrolled patients onto clinical trials (90.5%), used compassionate access programs (96.1%), and made special requests to government (91.8%). Other methods included writing false claims on forms to fit funding criteria for drugs (31.1%) and using leftover drug supplies (31.0%). Physicians felt their inability to obtain unfunded medications had a negative impact on their patients' clinical outcomes (56.0%) and psychosocial quality of life (73.0%). Only 28.5% of physicians contacted their governing body with concerns about oral chemotherapy funding.


CONCLUSIONS
Canadian physicians use numerous methods to obtain unfunded oral chemotherapies, including falsifying claims on access forms and submitting special requests to government agencies. Further study is warranted to explore the disconnection between policymakers and physicians with regard to funding of oral chemotherapies.
St Michael's Hospital; Sunnybrook Odette Cancer Centre; and University of Toronto, Toronto, Ontario, Canada.
Dolly
D
Han
Martina
M
Trinkaus
Sophie
S
Hogeveen
Muhammad
M
Mamdani
Scott R
SR
Berry
Raymond W
RW
Jang
Jeffrey S
JS
Hoch
Christine
C
Simmons
D000284:Administration, Oral; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D002170:Canada / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000592:standards / Q000706:statistics & numerical data; D010820:Physicians; D010818:Practice Patterns, Physicians'
D000970:Antineoplastic Agents