How the assessment works

Each jurisdiction is scored from 0 to 4 in eight categories, against published band definitions describing observable conditions — for example, whether a funded province-wide testing program is in effect, or whether pancreatic surgery is delivered in-province:

1. Provincial strategy & pancreatic-cancer focus — whether the cancer strategy names or reaches pancreatic cancer at all.
2. Biomarker & genetic testing access — whether funded testing pathways exist, and how comprehensive they are.
3. Drug coverage & patient out-of-pocket burden — how much of the cost of take-home cancer medicines falls on patients and private plans.
4. Clinical trials access — whether patients can reach trials without leaving the province.
5. Timely care — waits & surgical capacity — where pancreatic surgery and treatment are delivered, and what waits are documented.
6. Travel & transport support — what help exists when care is far from home.
7. Workforce, navigation & patient support — whether patients have navigators and the system has a workforce plan.
8. Research funding & national representation — whether the jurisdiction hosts pancreatic cancer research and sits in national decision-making.

Three rules govern the scoring. Missing data is never scored as zero: where the research holds no usable evidence for a category, the jurisdiction is marked "Not assessable," that category is excluded from its average, and the gap is disclosed. A low score is given only on evidence — including evidence of absence, such as a jurisdiction hosting no research grants. A minimum-evidence threshold applies: the overall grade is the equal-weight mean of the assessed categories, rounded to the nearest band and mapped 4→A, 3→B, 2→C, 1→D, 0→F, and a jurisdiction needs at least five of eight categories assessable to receive one. The numeric mean is published beside every letter grade, so a reader can see how close a jurisdiction sits to the band above or below.

The grades assess provincial systems — policy, funding, and service architecture. They are not a judgment on patients, families, individual clinicians, or individual hospitals.