A multicultural country needs to act multiculturally on all fronts; especially medically

BY MICHAEL THOMAS

“One thing that strikes home is these patients are dying because of their treatment, and not necessarily dying because the cancer has progressed.” These are sad, but true words spoken by Mayo Clinic cancer researcher Steven Offer.

A drug named Fluorouracil (5-FU) that is commonly prescribed to treat cancer, which can also have devastating effects on patients of certain races, is the subject of our concern in this article.

This drug is supposed to be used only on patients who are cleared of any of its adverse effects including death, however, this can only be clarified by a test that reveals whether or not the patient is compatible.

The problem is that only a few provinces in Canada observe such protocols. The research that cleared this drug for general use was done mainly to clear people of European descent, ignoring most other ethnic groups that make Canada multicultural.

Case in point is the late Dr. Anil Kapoor. Anil was a urologist and head of transplants at St. Joseph’s Healthcare, a hospital in Hamilton. He was diagnosed with stage four abdominal cancer and was prescribed Fluorouracil (5-FU) as treatment, but as we are about to find out, the treatment did not help him at all.

According to his family, he went from working to being bedridden in a matter of a day, or two, and died three weeks later, by the time they realized what his problem was, it was too late to save him.

According to Dr. Offer (who has been studying the genetic factors that increase the risk of a toxic reaction to 5-FU for 14 years), “While many cancer drugs can be toxic, what sets 5-FU apart is that severe illness and death is largely preventable.”

Dr. Anil Kapoor was one of the people who was allergic to this drug, but he, being of East Indian descent, should have been tested; however, this was not the case.

What is worst in this case, is that there is an antidote to toxic reactions called Uridine triacetate (brand name Vistogard) this can be purchased from the U.S. manufacturer to Canada under Health Canada’s Special Access Program, but it takes some time, time which patients like Kapoor did not have.

Here is a small sample of the effects of this drug on its patients from a numbers point of view. According to a 2020 Oncology journal article out of the U.S. “For every 1,000 patients treated with either FU, or capecitabine in the United States, 10 patients will die of treatment-related toxicity.” Capecitabine is the same drug in pill form.

A second study, which looked at data collected from 14,000 patients throughout North America, Asia and Europe, found 2.3% of patients with certain genetic variants died from 5-FU toxicity, compared to 0.1% of patients without the variants.

Just this year Ontario Health started routinely pre-screening, and when asked why it doesn’t pre-screen for more than four variants, the answer was, “There is limited, or no information available” on how other variants interact with 5-FU. It is important to note that Dr. Offer recommended that medical systems should pre-screen for at least 50 genetic variants that can lead to the deadly reaction.

Statistics Canada census numbers released earlier this year found 26.5% of the population is a “visible minority” (about 9.6 million people). Isn’t this reason enough for Health Canada to make this kind of screening mandatory nationwide?

This number includes Black people from all walks of life who live in this country. That said, since the four variant screening that Canada does is predominantly European geared, Blacks and other minorities should request to be tested for adverse reaction to Fluorouracil (5-FU) whenever cancer treatment is mentioned.

Sadly, as we have learned in this piece, had Kapoor received the correct screening based on his race and genetic make-up, he could have been alive today.

Plans to make the antidote available here have been considered but haven’t been cleared with Health Canada as yet.