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Nova Scotia rejects $900K request for cancer treatment covered by Ontario

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After three lines of chemotherapy and a clinical trial failed to cure Stephen Saunders, his doctors offered him hope: to send the Nova Scotia man to Boston and modify his T-cells to attack the cancer that’s otherwise left him with just months to live.

But at roughly $900,000 for treatment and the associated hospital stay, hope doesn’t come cheap.

Last week, Nova Scotia’s Health Department denied a funding request for Saunders, whose case highlights the ethical and economic dilemma that all provinces could soon be facing — whether to pay for a treatment that costs about five times more than other life-saving procedures like heart, lung and liver transplants.

Neither the health minister nor the medical director of the Nova Scotia Cancer Care Program would talk about the specifics of Saunders’s case.

But the Onslow Mountain man spoke openly to CBC about a life interrupted at 55 by a pain in his knee that turned out to be Stage 4 non-Hodgkins lymphoma. About how he tries to get in his 10,000 steps on the good days. And about how much he wants to live. 

« There’s all kinds of reasons why I want to stay living, things I want to do, » he said. « Watching my kids grow up and being with my partner… bigger projects, travel maybe if I could. »

The cost of a life

Work is underway to potentially offer CAR-T therapy closer to home, but that doesn’t change the question of funding. 

Health Canada approved the treatment in September and clinical trials have begun. And in about 18 months, the pan-Canadian Oncology Drug Review is expected to make a recommendation about the treatment’s value, which the provinces use when deciding whether it should be publicly covered.  

In the case of this treatment, it could be a life-and-death decision: in adults, CAR-T therapy is meant for patients whose blood cancer hasn’t responded to two or more lines of chemotherapy. 

Dr. Drew Bethune says that new treatments offer great promise but their cost can be challenging, especially when there’s limited data about their long-term success. (Steve Lawrence/CBC)

​ »It’s a very difficult world we live in, with very difficult heart-wrenching decisions, » said Dr. Drew Bethune, medical director of the cancer care program. Bethune is among those who advise the Health Department on whether to fund an out-of-province cancer care request, but he wouldn’t speak directly to Saunders’s case.

But he said that if looking at a request for CAR-T therapy, Nova Scotia would need to weigh the extreme cost, with the evidence of its success and how other Canadian patients who have received it have responded.

« As much as we just like to say, ‘Yes, let’s do it,’ it’s our responsibility to see what impacts it has on the whole [cancer] program, the expense of it. »

Other provinces

Exactly how many Canadians have gotten public coverage for the cancer therapy in the U.S. is unclear, but Ontario alone has sent 26 adult patients in the last two years, according to figures from that province’s Ministry of Health. 

Children might be more likely to qualify for out-of-province funding for this therapy, Bethune suggested. A 2018 clinical trial showed the children and young adults treated with CAR-T therapy had an 80 per cent chance of complete remission, while a trial involving adults with the same type of cancer as Saunders showed a 40 per cent complete remission rate.

« I think the evidence is fairly clear that the pediatric age group has a greater success rate with the treatment than the adult age group — but even in the adult age group some of the results are really excellent, » Bethune said.

And he said Nova Scotia would be watching how patients elsewhere in Canada have responded to CAR-T therapy.

Hailey MacDonald says it’s unfair that Ontario is paying for CAR-T therapy for some of its residents, while Nova Scotia has not offered to pay for her father. (Save Stephen Saunders/Facebook)

Saunders’s daughter, Hailey MacDonald, said the decision not to fund her father’s treatment is proof of the inequity in Canada’s health-care system.

The family can’t afford the cost on its own, but she’s holding out hope Nova Scotia may change its mind; she said she got a call from the Health Department on Friday saying it « hadn’t yet made a decision. » 

Her father is flying to the Dana-Farber Cancer Institute in Boston this week for a consultation, regardless of the response. 

« We understand as a family that this may not happen in time for my dad, » MacDonald said.

« We hope that that’s not the case, but there will be somebody else’s family member that will need this in the very near future. And Dad’s kind of paving the way for other patients. »

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‘Business as usual’ for Dorel Industries after terminating go-private deal

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MONTREAL — Dorel Industries Inc. says it will continue to pursue its business strategy going forward after terminating an agreement to go private after discussions with shareholders.

« Moving ahead. Business as usual, » a spokesman for the company said in an email on Monday.

A group led by Cerberus Capital Management had previously agreed to buy outstanding shares of Dorel for $16 apiece, except for shares owned by the family that controls the company’s multiple-voting shares.

But Dorel chief executive Martin Schwartz said the Montreal-based maker of car seats, strollers, bicycles and home furniture pulled the plug on a deal on the eve of Tuesday’s special meeting after reviewing votes from shareholders.

“Independent shareholders have clearly expressed their confidence in Dorel’s future and the greater potential for Dorel as a public entity, » he said in a news release.

Dorel’s board of directors, with Martin Schwartz, Alan Schwartz, Jeffrey Schwartz and Jeff Segel recused, unanimously approved the deal’s termination upon the recommendation of a special committee.

The transaction required approval by two-thirds of the votes cast, and more than 50 per cent of the votes cast by non-family shareholders.

Schwartz said enhancing shareholder value remains a top priority while it stays focused on growing its brands, which include Schwinn and Mongoose bikes, Safety 1st-brand car seats and DHP Furniture.

Dorel said the move to end the go-private deal was mutual, despite the funds’ increased purchase price offer earlier this year.

It said there is no break fee applicable in this case.

Montreal-based investment firm Letko, Brosseau & Associates Inc. and San Diego’s Brandes Investment Partners LP, which together control more than 19 per cent of Dorel’s outstanding class B subordinate shares voiced their opposition to the amended offer, which was increased from the initial Nov. 2 offer of $14.50 per share.

« We believe that several minority shareholders shared our opinion, » said Letko vice-president Stephane Lebrun, during a phone interview.

« We are confident of the long-term potential of the company and we have confidence in the managers in place.”

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Anglais

Pandemic funds helping Montreal businesses build for a better tomorrow

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Many entrepreneurs have had to tap into government loans during the pandemic, at first just to survive, but now some are using the money to better prepare their businesses for the post-COVID future.

One of those businesses is Del Friscos, a popular family restaurant in Dollard-des-Ormeaux that, like many Montreal-area restaurants, has had to adapt from a sit-down establishment to one that takes orders online for takeout or delivery.

“It was hard going from totally in-house seating,” said Del Friscos co-owner Terry Konstas. “We didn’t have an in-house delivery system, which we quickly added. There were so many of our employees that were laid off that wanted to work so we adapted to a delivery system and added platforms like Uber and DoorDash.”

Helping them through the transition were emergency grants and low-interest loans from the federal and provincial governments, some of which are directly administered by PME MTL, a non-profit business-development organization established to assist the island’s small and medium-sized businesses.

Konstas said he had never even heard of PME MTL until a customer told him about them and when he got in touch, he discovered there were many government programs available to help his business get through the downturn and build for the future. “They’ve been very helpful right from day one,” said Konstas.

“We used some of the funds to catch up on our suppliers and our rents, the part that wasn’t covered from the federal side, and we used some of it for our new virtual concepts,” he said, referring to a virtual kitchen model which the restaurant has since adopted.

The virtual kitchen lets them create completely different menu items from the casual American Italian dishes that Del Friscos is known for and market them under different restaurant brand names. Under the Prasinó Soup & Salad banner, they sell healthy Greek options and their Stallone’s Sub Shop brand offers hearty sandwiches, yet the food from both is created in the same Del Friscos kitchen.

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Downtown Montreal office, retail vacancies continue to rise

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Some of downtown Montreal’s key economic indicators are heading in the wrong direction.

Office and retail vacancies in the city’s central core continued to climb in the fourth quarter of 2020, according to a quarterly report released Thursday by the Urban Development Institute of Quebec and the Montréal Centre-Ville merchants association. The report, whose first edition was published in October, aims to paint a socio-economic picture of the downtown area.

The survey also found office space available for sublet had increased during the fourth quarter, which may foreshadow even more vacancies when leases expire. On the residential front, condo sales fell as new listings soared — a sign that the downtown area may be losing some of its appeal to homeowners.

“It’s impossible not to be preoccupied by the rapid increase in office vacancies,” Jean-Marc Fournier, the former Quebec politician who now heads the UDI, said Thursday in an interview.

Still, with COVID-19 vaccinations set to accelerate in the coming months, “the economic picture is bound to improve,” he said. “People will start returning downtown. It’s much too early to say the office market is going to disappear.”

Public health measures implemented since the start of the pandemic almost a year ago — such as caps on office capacity — have deprived downtown Montreal of more than 500,000 workers and students. A mere 4,163 university and CEGEP students attended in-person classes in the second quarter, the most recent period for which figures are available. Border closures and travel restrictions have also brought tourism to a standstill, hurting hotels and thousands of local businesses.

Seventy per cent of downtown workers carried out their professional activities at home more than three days a week during the fourth quarter, the report said, citing an online survey of 1,000 Montreal-area residents conducted last month.

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