Discrepancies between Canadian cancer research funding and site-specific cancer burden: a spotlight on ten disease sites.

Background: Cancer research is essential in evaluating the safety and effectiveness of emerging cancer treatments, which in turn can lead to ground-breaking advancements in cancer care. Given limited research funding, allocating resources in alignment with societal burden is essential. However, evidence shows that such alignment does not typically occur. The objective of the present study was to provide an updated overview of site-specific cancer research investment in Canada and to explore potential discrepancies between the site-specific burden and the level of research investment. Methods: The 10 cancer sites with the highest mortality in 2015-which included brain, female breast, colorectal, leukemia, lung, non-Hodgkin lymphoma, ovary, pancreas, prostate, and uterus-were selected for the analysis. Information about site-specific research investment and cancer burden (raw incidence and mortality) was obtained from the Canadian Cancer Research Survey and Statistics Canada's cansim (the Canadian Socio-Economic Information Management System) respectively. The ratio of site-specific research investment to site-specific burden was used as an indicator of overfunding (ratio > 1) or underfunding (ratio < 1). Results: The 3 cancer sites with the highest research investments were leukemia, prostate, and breast, which together represented 51.3% of 2015 cancer research funding. Conversely, the 3 cancer sites with the lowest investments were uterus, pancreas, and ovary, which together represented 7.8% of 2015 research funding. Relative to site-specific cancer burden, the lung, uterus, and colorectal sites were consistently the most underfunded. Conclusions: Observed discrepancies between cancer burden and research investment indicate that some cancer sites (such as lung, colorectal, and uterus) seem to be underfunded when site-specific incidence and mortality are taken into consideration.

The outcome of heart transplant recipients following the development of end-stage renal disease: analysis of the Canadian Organ Replacement Register (CORR).

End-stage renal disease is a significant complication of heart transplantation (HTx), but our understanding of dialysis outcomes in HTx recipients remains limited. We performed a retrospective analysis looking at dialysis mortality in HTx recipients as compared to a matched dialysis cohort. We also examined outcomes with respect to kidney transplantation (KTx) in these cohorts. 2709 incident HTx recipients were captured from the Canadian Organ Replacement Register between 1981 and 2002. The incidence of dialysis after HTx was 3.9% (n = 105) and carried a greater crude mortality compared to HTx recipients not requiring dialysis (56.2% vs. 35.9%, p < 0.001). Compared to the matched dialysis cohort, survival of HTx patients on dialysis was also significantly worse (19% vs. 40%, p = 0.003). In those receiving a KTx, survival did not differ between the two cohorts; however, in those that did not receive a KTx the survival was significantly lower in the dialysis post-HTx group compared to the matched dialysis cohort (15.7% vs. 35.2%, p < 0.025). Our analysis suggests mortality on dialysis following HTx is greater than would be expected from a similar dialysis population, and KTx may abrogate some of this increased risk. Attention should be placed on preventing chronic kidney disease progression following HTx.

Transplantation in Canada: report of the Canadian Organ Replacement Register.

The solid organ transplant rate in Canada grew from 49.5 per million population (PMP) in 1993 to 56.8 PMP in 2002, with a peak rate of 61.0 in 2000. Most of this increase was seen in living donor kidney, liver, and lung transplants where combined rates rose twofold, from 124.9 per 1000 transplants to 243.5. Despite this, the rate of organ transplantation in the United States was 150% that of Canada in 2002. As of December 31, 2002, there were 3,956 patients waiting for an organ transplant in Canada, an 84% increase in the total number of patients on the waiting list as of December 31, 1993, 10 years ago. Cadaveric organ donation did not change over this period. An international comparison of cadaveric organ donation rates for 2001 place Canada (13.5 PMP) well below Spain (32.5 PMP) and the United States (22.6 PMP) but above Australia (9.3 PMP). As a result the annual gap between transplants performed and the waiting list has grown from 927 in 1992 to 2230 in 2001, representing an annual increase of 8.3%.

Policy advocacy for public health practitioners: workshops on policy change.

This article describes two workshops on health-promoting policy change, developed and delivered to more than 1,000 public and community health practitioners across one Canadian province. The workshops were designed to increase knowledge about the process of policy change and provide opportunities for skill development. Three basic instructional methods--minilectures, individual pen-and-paper exercises, and small-group activities--were used. Workshops were delivered using a host organization arrangement, meaning organizations willing to host workshops could do so if they provided the venue and invited members of other organizations in the community. Initial evaluations indicate that practitioners find the workshops useful and that many have integrated the information into their day-to-day work. To the author's knowledge, no other workshops of this nature have been delivered in this systematic way.