Ottawa clinic's chief says delays prolong expensive treatments that may not be working
Wednesday 11 July 2001
The Ottawa Citizen
Delays of nearly a year in accessing MRI scans means multiple sclerosis patients are missing a critical window of opportunity to hold off the disease, says the head of the Ottawa Hospital's MS clinic.
MS patients need the magnetic resonance imaging (MRI) scans to track the progress of the unpredictable disease and fine tune drug treatments, said Dr. Mark Freeman.
While waiting for an MRI scan, many patients remain on one of four powerful drug treatments, even though the drug may no longer be working because the patient requires an MRI scan to confirm the drug's effectiveness. In other cases, the disease progresses very quickly. During the wait, chemotherapy, the most aggressive treatment of MS, is rendered useless.
"To get a scan a year down the road when we're ready to make a decision on treatment today is not helpful," said Dr. Freedman.
"The MRI gives us an impression as to what's happening even in people who are clinically stable," he sad.
"There are many, many people who are clinically stable whose disease is advancing significantly."
About 7,000 people are on a waiting list for a scan at either of the Ottawa Hospital's two MRI machines.
MS patients are listed as "semi-urgent" priorities on the hospital's waiting list, meaning they are supposed to receive their MRI within two months.
Tom Holland, the hospital's director of diagnostic imaging, said patients frequently wait longer for either scans that confirm an MS diagnosis or for follow-up scans that check the disease's progress.
The four drugs -- copaxone, avonex, betaseron and rebif -- modulate the immune system to reduce the disease's activity. The drugs are self-injected by the patient several times per week in most cases and cost between $15,000 and $25,000 annually, with costs covered mostly by the province.
The drugs are "modestly effective" but do not cure the disease, which remains active during the treatment, Dr. Freedman said.
More MS patients are being treated with the drugs than ever before, including most eligible patients at the Ottawa clinic who aren't participating in trials with newer drugs.
"If you're on some expensive treatment and six months later, your MRI showed considerable new activity, my question would be 'are you really responding to that drug?' " he said. "The MRI can help us in that (treatment) decision and when you're seeing someone that day, we want to be able to make that decision."
For patients not responding to one of the drugs, a different, more aggressive therapy would be required, Dr. Freedman said. "We would treat it actually like a tumour, with chemotherapy.
"But how am I supposed to make that decision? What am I going to do, wait another year to find that out? Meanwhile, the patient's progressed and maybe they've gone past the opportunity for the chemotherapy to help them. "For those patients who are rapidly advancing, we lose the opportunity to (use chemotherapy) and that opportunity should be there as much as possible."
Dr. Freedman's statements follow a report by the Ontario Association of Radiologists last week that ranked Eastern Ontario last, by a wide margin, in MRI machines per capita.
The region owns one machine for every 391,379 people, almost 75,000 more people per machine than the Central West region, the next worst region, according to the association's figures.
Dr. Leonard Avruch, supervising MRI radiologist at the Ottawa Hospital's General campus, said the waiting list includes "hundreds" of MS patients or patients where there is a suspicion of MS. (The hospital does not document why patients are waiting, only their priority classification.)
"It's a handicap that they can't get access to the MRIs when they need them," Dr. Avruch said.
"The major problem is, if it isn't working you're wasting a lot of money and that money should go to people that it does work on. So for the cost of a $300 scan, you're wasting thousands of dollars or more on therapy that may not be working."
The Ministry of Health maintains that when the next batch of MRI machines become available, the Eastern Ontario region will likely receive one, said Gord Haugh press secretary to Minister Tony Clement.
"The government has not relented in terms of adding MRIs to Ontario. There were 12 when the government took over and now there are 42 for the province," he said.
"It would be lovely to put another bunch of them out there but we can't do that. We have to add them at a reasonable pace because it is a very expensive technology and there are other demands in the health care system."
Dr. Freedman said he'd be happy if
his patients could get scans within a month or two, as neurologists receive
for their patients in other provinces.