[Hopespringpcsg] FW: ROBOTIC ASSISTED PROSTATE SURGERY with ATTACHMENT -MPP REPLY x3

Wed Sep 20 13:59:41 EDT 2017

Hi all:

Please see below for the reply to my e-mail on robotic assisted prostate
surgery which I had sent to the Health Minister as well as my MPP for
Guelph.

I will hold any reply in abeyance until I receive feedback from members of
the various PCCN chapters with which I had shared the original e-mail.

Take care,

Glen

From: Liz Sandals, MPP (Constituency Office)
[mailto:lsandals.mpp.co at liberal.ola.org] 
Sent: September 20, 2017 12:07 PM
To: 'Glen Tolhurst'
Subject: RE: ROBOTIC ASSISTED PROSTATE SURGERY with ATTACHMENT

Dear Glen :

Thank you for sending me a copy of the email which you sent to Minister
Hoskins.  I am sure that he will also respond to your email but I did want
to send you some information which I received from staff at the Ministry of
Health and Long Term Care.

Health Quality Ontario's (HQO)  Ontario Health Technology Advisory Committee
(OHTAC) thoroughly reviewed the evidence on robot-assisted radical
prostatectomies and found that although they are associated with some
improved short-term procedural outcomes (eg reduced length of stay and blood
loss) this did not translate to improved patient-important outcomes - HQO
found that robot-assisted prostatectomies do not produce any improvements in
pain, in health-related quality of life, in return to work or activity, in
hospital readmission rates, or in urinary and erectile function compared to
the usual, effective and safe, open surgical procedure.

HQO also found that robot-assisted procedures cost over $6000 more per
procedure than a prostatectomy done through the usual method, so the use of
surgical robots is currently coming at a prohibitively high cost for little
documented patient benefit.

The Ministry agrees with OHTAC's assessment that the use of robotic systems
in prostatectomies should not receive a special, higher payment than use of
the regular surgical approach.

However, the Ministry is aware of the potential for robotic procedures to
come down in cost over time and for benefits to increase with further
advances in this technology.  The Ministry remains open to adjusting its
funding policies when new evidence emerges on this topic.

In the interim, the Ministry acknowledges the concerns of hospitals about
the need to train future Ontario surgeons on the use of cutting edge
surgical technologies and is therefore working with the chairs of Ontario's
surgical training programs to understand potential ways the Ministry can
further support innovation in this critical area of healthcare.

Cancer Care Ontario's (CCO) Position Statement on Prostate Cancer Screening
using the Prostate-Specific Antigen (PSA) Test on randomized controlled
trials of prostate cancer screening using the PSA test have shown a small
reduction in prostate cancer mortality; however, harms associated with
screening are common. Given the potential harms of screening for PSA,
including over-diagnosis and over-treatment, CCO does not support an
organized, population-based screening program for prostate cancer. 

In October 2014, the Canadian Task Force on Preventative Health Care
(CTFPHC) released an updated guideline on screening for prostate cancer
using the prostate specific antigen (PSA) test.  Based on the balance
between the possible benefits and potential harms of early diagnosis and
treatment of prostate cancer, the CTFPHC recommends not screening for
prostate cancer with the PSA test.  Guideline development is based on a
systematic review of available literature, a broad consultation process and
scientific evidence synthesis.

Men who are concerned about their risk of prostate cancer should talk to
their primary care provider.  Individual decisions to screen should be made
as part of a shared decision-making process involving a discussion between a
man and his primary care provider.

CCO continues to monitor emerging evidence on prostate cancer screening.

I am  pleased to hear that you are a PCa survivor. 

Sincerely,

Liz

Office of Hon. Liz Sandals, MPP - Guelph

173 Woolwich St., Suite 102

Guelph, ON  N1H 3V4

T: 519-836-4190

F: 519-836-4191

From: Glen Tolhurst [mailto:glen46nor at gmail.com] 
Sent: August 28, 2017 2:27 PM 
Cc: Sandals, Liz MPP CO <lsandals.mpp.co at liberal.ola.org>
To: Hoskins, Eric MPP <ehoskins.mpp at liberal.ola.org>; Sandals, Liz MPP
<lsandals.mpp at liberal.ola.org>
Subject: ROBOTIC ASSISTED PROSTATE SURGERY with ATTACHMENT

From: Glen Tolhurst [mailto:Glen46Nor at gmail.com] 
Sent: August 28, 2017 2:15 PM
To: 'ehoskins.mpp at liberal.ola.org'; 'lsandals.mpp at liberal.ola.org'
Cc: 'lsandals.mpp.co at liberal.ola.org'
Subject: ROBOTIC ASSISTED PROSTATE SURGERY

Hon. Eric Hoskins & Hon. Liz Sandals:

The recent recommendation by the Ontario Health Technology Advisory
Committee (OHTAC) against public funding of robotic prostate cancer surgery
is simply short sighted and appalling.

As Chair of the Prostate Cancer Canada Network Waterloo- Wellington (PCCN
W-W) chapter, as well as being a member of 2 other Prostate Cancer Support
Groups (PCSG), I have met and interacted with a number of men diagnosed with
Prostate Cancer (PCa). These men cover the range from newly diagnosed,
through those treated by various modalities (surgery- robotic, open radical,
radiation therapy external beam -EBRT & Brachytherapy LDR & HDR, hormone
therapy, chemotherapy, High Intensity Focused Ultrasound-HIFU) to active
surveillance.  Amongst those PCSG members are the advanced cancer "warriors"
some of whom are metastatic.  In fact PCCN W-W lost a member to PCa
metastasis in June of 2016 and currently has several members with metastatic
PCa. 

Before either of you drag out the costs of robotic assisted prostate
surgery, be aware of the incremental costs of $3224/case of the procedure.
For 2015, there were 2400 radical prostatectomy surgeries in Ontario of
which 34% (or 814) were robotic assisted for a total cost of $3224 x 814 =
$2,624,336. As the President of the Treasury Board, (Hon Liz Sandals) should
surmise, this is miniscule in the scope of Ontario government spending.
Minister Hoskins, as a doctor, should be aware of the Quality of Life
positive impact of robotic assisted surgery as well as resultant cost
savings of shorter hospital stays and less blood loss. Furthermore as a
doctor he should recognize that robotic surgery decreases the impact of
bending over a patient during the procedure and thus aids in back stress
reduction of the surgeon. 

Additionally, it is incomprehensible why Ontario remains the only province
where men are charged to have a PSA test, unless they are diagnosed with PCa
or are a direct relative of a PCa patient, dead or alive.  Early detection
saves lives. In the Region of Waterloo Wellington, 8 men die from PCa every
month.

The next time you & your fellow MPPs gather in the legislature resplendent
in prostate cancer ties, neck scarves, & lapel pins perhaps the above
communication will really mean something to you.

You should then act to eliminate the de-funding of robotic surgery and
provide coverage for PSA testing.

Should you need further information, I attach the article by Dr. Neil
Fleshner that appeared in the Globe & Mail 28 Aug 17 explaining "Why we need
robots in our operating rooms".

BTW -  I am a PCa survivor due to  having paid for establishing a baseline
PSA level, being timely diagnosed with early stage PCa, and being treated at
the Princess Margaret Cancer Centre, which is 1 of the top 5 cancer research
centres in the world.

I trust you will not only provide a thoughtful reply but take the action
outlined above.

Remember, 2018 is a provincial election year.

Thank you,

Glen

Glen N. Tolhurst  P.Eng. MBA

Chair PCCN Waterloo- Wellington

web site:  <http://pccn-waterloo-wellington.ca/>
http://pccn-waterloo-wellington.ca/ 

e-mail:  <mailto:info at pccn-waterloo-wellington.ca>
info at pccn-waterloo-wellington.ca 

answering service 226-240-9264

Direct contact via:

Tel (519) 826-0716 

Cell (519) 994-4536

e-mail:  <mailto:Glen46Nor at gmail.com> Glen46Nor at gmail.com

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