About this snapshot. This audit is built on research conducted from June to August 2025 by student researchers in the foundation's Policy Builders of Tomorrow program. Key figures were independently verified by the foundation before publication (October 2026). The findings are a dated snapshot of the policies and programs in place in 2025; policies change, and developments after the research period are noted where they affect a published statement.
Executive summary
Pancreatic cancer is managed everywhere in Canada and prioritized nowhere. Across all thirteen provinces and territories, the student researchers found no organized pancreatic cancer screening program and no dedicated pancreatic cancer program. In several provinces, pancreatic cancer is not named in the provincial cancer strategy at all. What varies between jurisdictions is not whether pancreatic cancer has a dedicated place in the system, but how well the general system around it — testing, drug coverage, trials, surgery, travel support, navigation, and research funding — serves the people who develop it.
The headline findings:
- Strategy. All 13 jurisdictions record the same result: no pancreatic screening program, no dedicated pancreatic program. At the federal level, there are no federal recommendations for population-based pancreatic cancer screening and no federal guidelines on adopting validated early detection tools.
- Research funding. Of 88 pancreatic-cancer grants from the Canadian Institutes of Health Research (CIHR) in the register compiled for this research, totalling $23,354,337, six went to Atlantic Canada institutions — all in Nova Scotia, totalling $273,000. Newfoundland and Labrador, New Brunswick, and Prince Edward Island hosted none.
- Biomarker testing. Access is two-tier. Ontario operates the benchmark: a publicly funded comprehensive biomarker testing program rolled out from June 2021 and implemented province-wide by 2021/22. Within Atlantic Canada, Nova Scotia and New Brunswick have partial in-province capacity, while Newfoundland and Labrador and Prince Edward Island rely on send-out testing and out-of-province referral.
- Drug costs. A 2021 report by the Patented Medicine Prices Review Board (PMPRB) estimated that private plans and cash payments accounted for 59% of 2019 spending on selected take-home oncology medicines in the Atlantic groupings, compared with 12% in Alberta (full wording and sourcing in Section 4).
- Waits. Prince Edward Island recorded the longest median wait in Canada — 77.4 weeks from GP referral to treatment across all specialties (Fraser Institute, Waiting Your Turn 2024) — and Nova Scotia recorded 39.1 weeks. These are all-specialty medians, not pancreatic cancer waits; pancreatic-specific waits are published nowhere the researchers could find.
- Travel. In the 2025 research period, Atlantic pancreatic surgery was centralized in Halifax and St. John's, and trial access in the region was assessed as extremely limited. Patients routinely travel between provinces for care, and existing travel support is largely reimbursement-based, income-tested, or both. Since this research was completed, The Moncton Hospital completed Atlantic Canada's first robotic Whipple procedure (announced September 2026).
The foundation graded each jurisdiction against its own eight-category rubric (Section 1). Six jurisdictions had enough evidence to grade. Seven did not, and are published as "Insufficient data — not graded," with the categories that could be assessed still shown.
| Jurisdiction | Overall grade | Mean | Categories assessed |
|---|---|---|---|
| Ontario | A | 3.6 | 7 of 8 |
| British Columbia | B | 2.5 | 6 of 8 |
| Nova Scotia | C | 2.1 | 8 of 8 |
| Newfoundland and Labrador | C | 1.6 | 8 of 8 |
| New Brunswick | C | 1.6 | 8 of 8 |
| Prince Edward Island | D | 1.1 | 7 of 8 |
| Quebec | Insufficient data — not graded | 2.3* | 4 of 8 |
| Alberta | Insufficient data — not graded | 2.7* | 3 of 8 |
| Manitoba | Insufficient data — not graded | 2.3* | 3 of 8 |
| Saskatchewan | Insufficient data — not graded | 2.3* | 3 of 8 |
| Nunavut | Insufficient data — not graded | 1.0* | 2 of 8 |
| Northwest Territories | Insufficient data — not graded | 1.0* | 1 of 8 |
| Yukon | Insufficient data — not graded | 0.0* | 1 of 8 |
* Mean of assessed categories only, shown for transparency. No overall grade is published below the five-of-eight evidence threshold.
The grades assess provincial systems — policy, funding, and service architecture. They are not a judgment on patients, families, individual clinicians, or individual hospitals.
1. About this research
The program
Policy Builders of Tomorrow was a student research program run by The Heather Cutler Foundation in the summer of 2025. The Heather Cutler Foundation is Atlantic Canada's trusted voice for pancreatic cancer. Supporting Canadians living with pancreatic cancer, caregivers, and advancing research & care.
The program ran for three months, from June to August 2025, in a fully online format, and brought together a cohort of seven Memorial University undergraduate students: Arafa Hossain, Charlotte Campbell, Grace Fitzgerald, Rayah Vokey, Seriman Doumbia, Chaturrvi Maruthireddy, and Kimia Rezaeinejad. It was led by foundation staff and supported by cross-sector mentors with backgrounds in health research, public policy, advocacy, and healthcare administration, who provided structured, phase-based feedback throughout.
The researchers built inventories rather than opinions: a cancer strategy database covering all thirteen provinces and territories; a biomarker testing policy database recording funded pathways jurisdiction by jurisdiction; implementation, infrastructure, and transport matrices; assessments of Atlantic representation in national bodies, workforce policy, and rural and Indigenous cancer care; and a register of federal pancreatic cancer research funding. The work proceeded through thirteen modules, from mapping the policy landscape, through the points where care is decided — trials, testing, drug approval — to document verification, timeline cross-referencing, and a closing coverage audit.
The grading rubric
The grades in this audit are the foundation's own assessment layer, built on the student inventories. No student document assigned grades to provinces. The rubric scores each jurisdiction from 0 to 4 in eight categories:
- Provincial strategy & pancreatic-cancer focus
- Biomarker & genetic testing access
- Drug coverage & patient out-of-pocket burden
- Clinical trials access
- Timely care — waits & surgical capacity
- Travel & transport support
- Workforce, navigation & patient support
- Research funding & national representation
Each category is scored 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. Three rules govern the scoring:
- Missing data is never scored as zero. Where the research contains no usable evidence for a category, the jurisdiction is marked "Not assessable" for that category. Not assessable is excluded from the average, and the gap is disclosed. A low score is given only on evidence — including evidence of absence, such as a jurisdiction hosting zero research grants.
- A minimum-evidence threshold. The overall grade is the equal-weight mean of the assessed categories, rounded to the nearest band (.5 rounds up) and mapped 4→A, 3→B, 2→C, 1→D, 0→F. A jurisdiction needs at least five of eight categories assessable to receive an overall grade; below that it is published as "Insufficient data — not graded," with its assessed categories still shown.
- The mean is published beside the grade, so a reader can see how close a jurisdiction sits to the band above or below.
Two simplifications are declared rather than hidden. Category 5 rests primarily on where pancreatic surgery and systemic therapy are delivered, because numeric wait times exist in the research for only two provinces and are not pancreatic-specific. Category 8's representation evidence measures Atlantic representation only; for non-Atlantic jurisdictions that category rests on hosted research funding and infrastructure.
Verification and the conflicts rule
Before publication, the foundation independently verified the key figures in this audit against primary sources (October 2026). One rule governed the process: nothing published may contradict itself. Every conflict found in the research was resolved in one of three ways — a correct value verified from an authoritative source; both values published with the discrepancy disclosed; or the item omitted and labelled "data not obtainable." Unobtainable data is stated as such. It is never filled in. Section 6 lists what could not be verified and what judgment calls the scoring required.
A note on this research
This research was conducted by student researchers as part of an educational program. The Heather Cutler Foundation reviewed the work and independently verified key figures before publication, but errors may remain. The findings are a dated snapshot of the policies and programs in place in 2025, and policies change. If you spot an error, we welcome corrections through the foundation's error-reporting page.
2. National findings by theme
2.1 Strategy & pancreatic focus
Every jurisdiction records the same finding: no organized or population-based pancreatic cancer screening program, and no dedicated pancreatic cancer program. Pancreatic cancer is managed within general oncology services everywhere. Some strategies do not name it at all — Manitoba's "does not explicitly highlight pancreatic cancer," and Saskatchewan's does not highlight it "as a distinct focus." Ontario's Cancer Plan 6 (2024–2028) comes closest to a pathway, referencing rare and complex cancers generally with referral pathways, but with no targeted pancreatic initiatives. The territories are thinnest: Yukon has no standalone cancer strategy equivalent to a provincial agency, and Nunavut has no standalone cancer agency; care in both runs by referral south. Federally, there are no recommendations for population-based pancreatic screening and no guidelines on adopting validated early detection tools.
2.2 Biomarker & genetic testing
Testing access is the audit's clearest two-tier finding. Ontario's publicly funded comprehensive biomarker testing program rolled out from June 2021 and was implemented province-wide by 2021/22, with standardized public funding and coordination covering BRCA1/2 germline testing, tumour MSI/dMMR, NTRK, and other pancreatic-relevant markers. (January 1, 2024 is the effective date from which the program's currently listed indications are funded, not its launch.) British Columbia's Cancer Genetics & Genomics Laboratory holds a provincial mandate for molecular diagnostics for all cancer patients; Alberta Precision Laboratories' Cancer Genomics Program provides NGS testing covering BRCA, MSI, and other relevant markers; CancerCare Manitoba's Molecular Diagnostics Expansion is in effect; and Quebec's INESSS/RQDM process adds genomic tests to its Répertoire and supports NGS repatriation. In Atlantic Canada, Nova Scotia has in-province sequencing at the QEII Health Sciences Centre and New Brunswick's Horizon Health runs a pan-cancer panel that explicitly lists pancreas — but neither has a comprehensive funded province-wide program. Newfoundland and Labrador's laboratory formulary funds BRCA1/2 and hereditary colorectal panels under an entry dated 2019, the oldest in the inventory; broader profiling requires send-out testing. Prince Edward Island has no in-province pathway at all. The biomarker database contains no entries for the three territories. A pan-Canadian evidence paper recorded that 65% of comprehensively tested patients faced challenges accessing testing.
2.3 Drug coverage & patient costs
A 2021 PMPRB report estimated that private plans and cash payments accounted for 59% of 2019 spending on selected take-home oncology medicines in New Brunswick, Nova Scotia, and the combined PEI–Newfoundland and Labrador market, compared with 12% in Alberta. The figure is a share of spending on 47 selected take-home medicines, paid by private plans and cash combined — not a measure of what individual patients paid out of pocket. A separate published estimate put average take-home cancer drug costs at an estimated $6,000 per month (CanCertainty, as cited in MacPhail & Snow 2022). The Atlantic provinces have no income-based drug program equivalent to Ontario's Trillium Drug Program, which caps out-of-pocket costs relative to household income; Ontario also runs an Exceptional Access Program deciding case-by-case requests in three days to six weeks with backdating, and a New Drug Funding Program under which patients pay $0 for covered in-hospital IV drugs. Province-by-province cost figures within Atlantic Canada were not obtainable (Section 6).
2.4 Clinical trials access
The research's verdict on Atlantic Canada is direct: "Pancreatic cancer trials access in Atlantic Canada is extremely limited." Nationally, enrolment is concentrated: about 7% of Canadian cancer patients enrol in trials; Toronto's Princess Margaret Cancer Centre reports 21%, while smaller regions report 3–4%. One research document recorded Montreal at 34% of trial activity and Nova Scotia at 2.6% (figures as recorded). Decentralized models are the main counterweight: the CRAFT pilot runs in British Columbia, Ontario, and Newfoundland and Labrador, with a satellite research site in Grand Falls–Windsor; Horizon Health Network has implemented decentralized trials on a digital platform; the Atlantic Clinical Cancer Research Unit (Nova Scotia Health) in Halifax was reported with 45–55 trials in start-up and 20–25 active; and the Toronto-based COMPASS pancreatic sequencing program expanded one site to Halifax.
2.5 Timely care — waits & surgical capacity
Numeric wait times exist in the research for two provinces only, from a single source, and measure all specialties, not pancreatic cancer. Prince Edward Island's median wait from GP referral to treatment was 77.4 weeks (Fraser Institute, Waiting Your Turn 2024) — the longest in Canada, with the Fraser Institute cautioning that PEI's smaller survey sample warrants care in interpretation. Nova Scotia's was 39.1 weeks (2024). During the research period, Atlantic pancreatic surgery was centralized in Halifax and St. John's; PEI's Whipple-eligible cases were typically performed in Halifax. Since this research was completed, The Moncton Hospital completed Atlantic Canada's first robotic Whipple procedure (announced September 2026). Nova Scotia's public wait-time dashboard includes pancreas surgery for pancreatic cancer — one of the few places in the country where a pancreatic surgical wait is published at all.
2.6 Travel & transport support
Because specialized care is centralized, travel support is a core part of treatment access in Atlantic Canada. Newfoundland and Labrador's Medical Transportation Assistance Program (MTAP) cost-shares airfare, mileage, accommodations, and meals for eligible out-of-area care; student assessors rated it 3 of 5, citing the up-front payment burden, documented as capable of delaying treatment starts for rural and Labrador patients. Nova Scotia's Boarding, Transportation and Ostomy Program funds travel over 50 km one-way but is income-tested at a $35,000 gross family income threshold documented as excluding many rural residents. PEI's Maritime Bus Subsidy (100% or 50% by income) and its Hope Air partnership were each rated 4 of 5. Charitable lodging scores highest: Daffodil Place (St. John's) and The Lodge That Gives (Halifax) were each rated 5 of 5. Federally, the Non-Insured Health Benefits program provides medical transportation for eligible First Nations and Inuit patients. Outside Atlantic Canada, the only patient-cost support the research could score was British Columbia's donor-funded Patient Relief Fund; Ontario's provincial travel support was not documented and is marked not assessable.
2.7 Workforce, navigation & support
Across ten federal and provincial workforce policies, three gaps recur: no oncology or diagnostic workforce targets; weak retention mechanisms beyond initial bonuses or debt forgiveness; and overreliance on locums and pilot programs. The Atlantic Locum & Recruitment Program was rated "Not adequate: only short-term fix." Navigation is a documented regional strength in places: Nova Scotia's Cancer Patient Navigation Program (province-wide, oncology-certified navigators, since the early 2000s); oncology nurses as navigators in Labrador-Grenfell; and twelve Indigenous Patient Navigators at Horizon Health as of 2025. Ontario's "Your Symptoms Matter" patient-reported outcomes program has operated province-wide since 2017. Across 26 Indigenous cancer care policies, navigation infrastructure exists in all four Atlantic provinces, but cultural-safety standards are not consistently mandated, traditional healing is often facilitated informally rather than encoded in policy, and Indigenous self-determination in cancer care is "partially supported but rarely codified."
2.8 Research funding & national representation
The CIHR register compiled for this research contains 270 grant records totalling $102,717,028 (competitions September 2008 to November 2024), concentrated at the University of British Columbia (46 records), the University of Toronto (40), University Health Network (30), and McGill University (21). Of the 88 records flagged as pancreatic-cancer research, totalling $23,354,337, Atlantic institutions hold six — all in Nova Scotia, totalling $273,000. On representation, the research assessed 29 national health initiatives against Atlantic Canada's 6.8% population share: 15 sit above parity, 4 near parity, and 10 under-represented; the median number of Atlantic seats per initiative is one. The strongest Atlantic presence is the Atlantic Cancer Consortium's Patient Advisory Committee, at approximately four of twelve public members, equally from all four provinces. The most consequential gap is opacity: the membership of Canada's Drug Agency's pCODR Expert Review Committee, which recommends which cancer drugs public plans should fund, is not publicly disclosed.
3. Jurisdiction profiles
Scores are out of 4 per category. "Not assessable" means the research held no usable evidence for that category; it is excluded from the mean, never scored as zero. Surgical locations are stated as of the 2025 research period: since this research was completed, The Moncton Hospital completed Atlantic Canada's first robotic Whipple procedure (announced September 2026).
Newfoundland and Labrador — Overall: C (mean 1.6, based on 8 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 2 | Care runs through the NL Health Services Provincial Cancer Care Program, with budget lines for travel support (MTAP), telehealth, and oncology investment; no dedicated pancreatic program. |
| 2 | Biomarker & genetic testing | 1 | The laboratory formulary funds BRCA1/2 and hereditary colorectal panels (entry dated 2019, the oldest in the inventory); broader profiling requires send-out testing or interprovincial arrangements. |
| 3 | Drug coverage & patient costs | 1 | No income-based drug program equivalent to Ontario's Trillium. Scored on the Atlantic regional PMPRB figure (Section 4); no NL-specific figure was obtainable. |
| 4 | Clinical trials access | 2 | Teleoncology operates across all regions; NL is a CRAFT pilot province, with a satellite research site in Grand Falls–Windsor; pancreatic trial access is nonetheless "extremely limited." |
| 5 | Timely care — waits & surgical capacity | 2 | Pancreatic and HPB surgery is provided in-province at a single centre (Health Sciences Centre / Bliss Murphy, St. John's). No NL-specific wait figure was obtainable. |
| 6 | Travel & transport support | 2 | MTAP cost-shares airfare, mileage, accommodations, and meals (referral required); rated 3 of 5 by student assessors, citing the up-front payment burden. Daffodil Place lodging rated 5 of 5. |
| 7 | Workforce, navigation & support | 2 | Oncology nurses serve as navigators in Labrador-Grenfell. The Rural Physician Incentive is "partially adequate" for recruitment; retention is weak, allied health excluded. |
| 8 | Research funding & representation | 1 | No CIHR pancreatic grant hosted in NL (0 of 88). NL participates in the Atlantic Cancer Consortium, holds a seat on 3CTN's Management Committee, and has a voting NACI member from the Department of Health and Community Services. |
Care is centred on the Dr. H. Bliss Murphy Cancer Centre in St. John's; within MTAP, Air Daffodil provides three flights a year for rural Labrador patients. The province also sits inside a larger federal funding context: the Canada–Newfoundland and Labrador Working Together Agreement (signed March 25, 2024) provides approximately $256 million over three years for family health services, health workers and backlogs, mental health, and health data — general health funding, not a cancer allocation.
Nova Scotia — Overall: C (mean 2.1, based on 8 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 2 | Care runs through the Nova Scotia Health Cancer Care Program within the Action for Health plan (2023), including about $3M to implement the lung screening program launched January 2024; no pancreatic-specific program. |
| 2 | Biomarker & genetic testing | 2 | In-province NGS operates at the QEII Health Sciences Centre (Illumina NextSeq 2000); germline testing for the Maritimes runs through the Maritime Medical Genetics Service; no comprehensive funded province-wide program. |
| 3 | Drug coverage & patient costs | 1 | Scored on the Atlantic regional PMPRB figure (Section 4). One NS-specific datum: rural NS patients spend around 4% of income before coverage. |
| 4 | Clinical trials access | 2 | Hosts the Atlantic Clinical Cancer Research Unit (Nova Scotia Health), reported with 45–55 trials in start-up and 20–25 active; COMPASS expanded a site to Halifax; regional pancreatic trial access remains "extremely limited." |
| 5 | Timely care — waits & surgical capacity | 2 | Pancreatic surgery is centralized in-province at a single centre (Halifax). Median wait from GP referral to treatment: 39.1 weeks (Fraser Institute, Waiting Your Turn 2024). |
| 6 | Travel & transport support | 2 | The Boarding, Transportation and Ostomy Program funds travel over 50 km one-way but is income-tested at a $35,000 gross family income threshold documented as excluding many rural residents. The Lodge That Gives rated 5 of 5. |
| 7 | Workforce, navigation & support | 3 | The Cancer Patient Navigation Program — province-wide, oncology-certified navigators, since the early 2000s — is an Atlantic strength. The Nursing Strategy is "Adequate" for supply but has no oncology specialization track. |
| 8 | Research funding & representation | 3 | All six Atlantic CIHR pancreatic grants are NS-hosted, totalling $273,000 (Dalhousie ×5; Nova Scotia Health Authority ×1). A Dalhousie member chairs 3CTN's Management and Executive Committee. |
Nova Scotia is the region's research and treatment hub — its higher grade reflects that concentration, not a pancreatic program, which it does not have.
New Brunswick — Overall: C (mean 1.6, based on 8 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 2 | The New Brunswick Cancer Network coordinates services under the Department of Health; the 2024–25 budget includes $2.9M for screening and oncology drug funding; no pancreatic-specific program. |
| 2 | Biomarker & genetic testing | 2 | Horizon Health's Molecular Oncology Pan Cancer Solid Tumor Panel explicitly lists pancreas and is available in-province (January 2025); germline referrals to IWK or in-province clinics; no comprehensive funded program. |
| 3 | Drug coverage & patient costs | 1 | Scored on the Atlantic regional PMPRB figure (Section 4). No NB-specific figure was obtainable. |
| 4 | Clinical trials access | 2 | Horizon has implemented decentralized trials with a digital platform, and NB collaborates formally with Nova Scotia for specialized services and shared trials; regional pancreatic access remains "extremely limited." |
| 5 | Timely care — waits & surgical capacity | 1 | No in-province pancreatic surgery in the research period (centralized in Halifax and St. John's — see the Moncton note above); systemic and radiation therapy are delivered in Saint John and Moncton. No NB wait figure was obtainable; the research states only that NB "also has very long wait times." |
| 6 | Travel & transport support | 2 | New Brunswick Medical Transportation covers out-of-province care, rated "Moderate" — "limited coverage scope, basic travel assistance only." Lodging at Mgr. Henri-Cormier, Moncton. |
| 7 | Workforce, navigation & support | 2 | The Health Human Resource Plan is "Partially adequate: broad scope," with weak cancer/diagnostic focus and weak retention; navigation is characterized as robust, and Horizon reached twelve Indigenous Patient Navigators in 2025. |
| 8 | Research funding & representation | 1 | No CIHR pancreatic grant hosted in NB (0 of 88). NB participates in the Atlantic Cancer Consortium. |
Prince Edward Island — Overall: D (mean 1.1, based on 7 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 2 | The PEI Cancer Action Plan 2023–2028 (launched February 28, 2023) sets five priorities and four enablers, with about $2 million identified across screening, referrals, and consortium integration; no PEI-specific pancreatic programs. |
| 2 | Biomarker & genetic testing | 0 | No in-province testing pathway: access runs solely under the out-of-province access policy, with germline testing via the Maritime Medical Genetics Service in Halifax. |
| 3 | Drug coverage & patient costs | 1 | Scored on the Atlantic regional PMPRB figure (PEI & NL combined; Section 4). The implementation research flags take-home drug coverage disparities — patients "don't have full coverage for all types of medication." |
| 4 | Clinical trials access | 1 | No local trial infrastructure documented; access by cross-provincial referral, recorded as functional, with navigation support via Health PEI. |
| 5 | Timely care — waits & surgical capacity | 1 | No in-province pancreatic surgery in the research period — Whipple-eligible cases are typically performed in Halifax — while systemic therapy is delivered in Charlottetown and Summerside. PEI also carries the longest documented wait: 77.4 weeks, median GP referral to treatment, all specialties (Fraser Institute, 2024). The score rests on surgical location under this category's declared simplification (Section 6). |
| 6 | Travel & transport support | 2 | The Maritime Bus Subsidy (income-based 100%/50%) and the Hope Air partnership were each rated 4 of 5; a hotel subsidy exists; constraints include approval ten days before travel and a single carrier's schedules. |
| 7 | Workforce, navigation & support | Not assessable | Not obtainable: PEI-specific workforce and navigation policy is not covered; PEI appears only inside regional workforce analyses. |
| 8 | Research funding & representation | 1 | No CIHR pancreatic grant hosted in PEI (0 of 88). PEI participates in the Atlantic Cancer Consortium, whose patient advisory committee holds equal representation from all four provinces. |
Ontario — Overall: A (mean 3.6, based on 7 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 3 | Cancer Plan 6 (2024–2028) sets five goals — equity; patient experience; system integration; workforce sustainability; research, innovation and data — through 14 Regional Cancer Programs, and references rare and complex cancers with referral pathways; no targeted pancreatic initiatives. |
| 2 | Biomarker & genetic testing | 4 | The Comprehensive Cancer Biomarker Testing Program provides standardized province-wide public (OHIP) funding and coordination (BRCA1/2, MSI/dMMR, NTRK, and other pancreatic-relevant markers). It rolled out from June 2021 and was implemented province-wide by 2021/22; January 1, 2024 is the effective date for its currently listed indications. The benchmark program in this audit. |
| 3 | Drug coverage & patient costs | 4 | All three protective mechanisms in the research: Trillium (since 1995) caps out-of-pocket costs relative to income; the Exceptional Access Program (since 2016) decides in three days to six weeks with backdating; the New Drug Funding Program leaves patients at $0 for covered in-hospital IV drugs. Ontario's own private-pay share is not in the research; the score rests on program architecture. |
| 4 | Clinical trials access | 4 | The national concentration point: Princess Margaret reports 21% enrolment against about 7% nationally; the Toronto-based COMPASS pancreatic sequencing program operates from Ontario (one Halifax site). Also a CRAFT pilot province. |
| 5 | Timely care — waits & surgical capacity | 3 | Care is delivered within a multi-centre tertiary and regional system (14 Regional Cancer Programs). No Ontario wait figure, overall or pancreatic-specific, was obtainable. |
| 6 | Travel & transport support | Not assessable | Not obtainable: no Ontario provincial travel-support program is documented in the research. |
| 7 | Workforce, navigation & support | 3 | Workforce Sustainability is a named Plan 6 goal, and the "Your Symptoms Matter" patient-reported outcomes program has run province-wide since 2017. No Ontario workforce adequacy rating was obtainable. |
| 8 | Research funding & representation | 4 | Ontario institutions dominate the register: University of Toronto (40 records) and University Health Network (30) lead the 270-record CIHR register, and its largest pancreatic-related grant ($2,778,938, Sinai Health) is Ontario-hosted. The representation research measures Atlantic representation only; the score rests on hosted funding and infrastructure. |
Ontario's A comes from the aggregation rule, not any single category: it scores 3 or 4 on every assessable category, and its one unassessed category is excluded rather than zeroed. It is the strongest system in Canada on this evidence — and it still has no dedicated pancreatic program.
British Columbia — Overall: B (mean 2.5, based on 6 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 2 | The 10-Year Cancer Action Plan (2023–2033) carries an initial $440 million investment (2023) through six regional cancer centres, with reported first-year hiring of over 70 oncologists and 30 radiation therapists; no pancreatic-specific provisions documented. |
| 2 | Biomarker & genetic testing | 3 | The Cancer Genetics & Genomics Laboratory holds a provincial mandate for molecular diagnostics for all BC cancer patients, recorded "In effect"; no Ontario-type standardized funding-and-coordination program is described. |
| 3 | Drug coverage & patient costs | Not assessable | Not obtainable: BC's drug coverage architecture and patient costs are not covered in the research. (The relief fund below is scored under Category 6.) |
| 4 | Clinical trials access | 2 | A CRAFT pilot province, listed among provinces with trial sites. No BC enrolment rate or pancreatic-specific trial program is documented. |
| 5 | Timely care — waits & surgical capacity | Not assessable | Not obtainable: the research does not state where pancreatic surgery for BC patients is delivered and has no BC wait figure. |
| 6 | Travel & transport support | 1 | The only documented support is charitable: the BC Cancer Foundation's donor-funded Patient Relief Fund (established about 2019). No BC provincial travel program is documented. |
| 7 | Workforce, navigation & support | 3 | A province-wide integrated outcomes platform (OaSIS/COSI); the plan's first year filled over 325 FTE positions including oncologists and radiation therapists and established eight Indigenous patient navigator positions; no retention mechanisms documented. |
| 8 | Research funding & representation | 4 | UBC holds the largest institutional share of the CIHR register (46 of 270 records), and BC hosts a major pancreatic-flagged grant at Simon Fraser University ($994,500). The representation research measures Atlantic representation only; the score rests on hosted funding and infrastructure. |
Quebec — Overall: Insufficient data — not graded (mean of assessed categories 2.3, based on 4 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 2 | The Plan d'action en cancérologie 2024–2026 sets eight strategic axes with orientations to 2030 and published screening targets; no pancreatic-specific provisions documented. |
| 2 | Biomarker & genetic testing | 2 | An INESSS/RQDM process exists to add genomic tests to the Répertoire, and the RQDM supports NGS repatriation ("Ongoing"); no comprehensive funded province-wide program documented. |
| 3 | Drug coverage & patient costs | Not assessable | Not obtainable: not covered beyond Quebec's separate drug-review structure — it sits outside pCODR, and its separate system is noted as limiting pan-Canadian coherence. |
| 4 | Clinical trials access | 3 | Montreal is recorded at 34% in the research's trial-activity concentration figures; Quebec is listed among provinces with trial sites. No Quebec enrolment rate is documented. |
| 5 | Timely care — waits & surgical capacity | Not assessable | Not obtainable: not covered in the research. |
| 6 | Travel & transport support | Not assessable | Not obtainable: not covered in the research. |
| 7 | Workforce, navigation & support | Not assessable | Not obtainable: not covered in the research. |
| 8 | Research funding & representation | 2 | McGill accounts for 21 of the 270 records in the CIHR register, one of four concentration institutions. Institution-level counts within the 88 pancreatic-flagged records are not published beyond the largest grants; the score rests on register presence. |
Alberta — Overall: Insufficient data — not graded (mean of assessed categories 2.7, based on 3 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 2 | The Cancer Strategic Clinical Network Plan 2024–2027 and "Changing Our Future: Alberta's Cancer Plan to 2030" set three strategic directions through CancerControl Alberta; no pancreatic-specific provisions documented. |
| 2 | Biomarker & genetic testing | 3 | Alberta Precision Laboratories' Cancer Genomics Program provides NGS testing covering BRCA, MSI, and other pancreatic-relevant markers ("Operational"). |
| 3 | Drug coverage & patient costs | 3 | The research's measured low private-pay share: 12% of take-home oncology spending privately paid versus up to 59% in the Atlantic groupings — 88% public funding (PMPRB 2021, 2019 data). Exceptional-access timelines are not documented. |
| 4 | Clinical trials access | Not assessable | Not obtainable: Alberta is listed among provinces with trial sites, but no enrolment rate, site detail, or pancreatic-trial evidence is in the research. |
| 5 | Timely care — waits & surgical capacity | Not assessable | Not obtainable: not covered in the research. |
| 6 | Travel & transport support | Not assessable | Not obtainable: not covered in the research. |
| 7 | Workforce, navigation & support | Not assessable | Not obtainable: not covered in the research. |
| 8 | Research funding & representation | Not assessable | Not obtainable: Alberta's institution-level register presence is not published in the research. Alberta's Tomorrow Project (cohort of about 55,000, since 2000) is research infrastructure, not pancreatic research funding. |
Manitoba — Overall: Insufficient data — not graded (mean of assessed categories 2.3, based on 3 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 2 | CancerCare Manitoba's Strategic Framework 2024–2029 governs care from Winnipeg plus 11 regional oncology clinics; it "does not explicitly highlight pancreatic cancer." |
| 2 | Biomarker & genetic testing | 3 | The Molecular Diagnostics Expansion is recorded "In effect" (November 2024). Its marker-level scope is not detailed in the research. |
| 3 | Drug coverage & patient costs | Not assessable | Not obtainable: not covered in the research. |
| 4 | Clinical trials access | Not assessable | Not obtainable: not covered in the research; the Community Oncology Program concerns treatment delivery, not trials. |
| 5 | Timely care — waits & surgical capacity | Not assessable | Not obtainable: surgical location and wait times are not covered in the research. |
| 6 | Travel & transport support | Not assessable | Coordinated travel support for northern and remote communities is documented as existing, but its terms — funding, lodging, prepayment, eligibility — are not in the research, so no band can be placed honestly. |
| 7 | Workforce, navigation & support | 2 | The Aboriginal Cancer Care Program provides Indigenous Patient Navigators with traditional-healing integration, and the Community Oncology Program of shared-care clinics is rated "High" as a decentralized care model. No Manitoba workforce-policy adequacy rating exists in the research. |
| 8 | Research funding & representation | Not assessable | Not obtainable: register counts are published only for the concentration institutions and Atlantic provinces; Manitoba's presence cannot be determined from them. |
Saskatchewan — Overall: Insufficient data — not graded (mean of assessed categories 2.3, based on 3 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 2 | The Saskatchewan Cancer Agency Strategic Plan 2024–2028 is in operation, with population screening including mobile units and telehealth links; "pancreatic cancer is not highlighted as a distinct focus." |
| 2 | Biomarker & genetic testing | 2 | A funding approval framework for molecular biomarker testing is "Established" (July 2024); no operating program is documented. |
| 3 | Drug coverage & patient costs | Not assessable | Not obtainable: not covered in the research. |
| 4 | Clinical trials access | Not assessable | Not obtainable: not covered in the research. |
| 5 | Timely care — waits & surgical capacity | Not assessable | Not obtainable: not covered in the research. |
| 6 | Travel & transport support | Not assessable | Not obtainable: not covered in the research. |
| 7 | Workforce, navigation & support | Not assessable | Not obtainable: not covered beyond telehealth links for supportive care. |
| 8 | Research funding & representation | 3 | One major pancreatic-flagged grant: the University of Saskatchewan's MUC-16 radioimmunoconjugate program (ovarian and pancreatic), $979,200. |
Yukon — Overall: Insufficient data — not graded (mean of assessed categories 0.0, based on 1 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 0 | "No standalone territorial cancer strategy equivalent to provincial cancer agencies"; care runs by referral to BC and Ontario. |
| 2 | Biomarker & genetic testing | Not assessable | Not obtainable: the biomarker database has no entries for Yukon. |
| 3 | Drug coverage & patient costs | Not assessable | Not obtainable: not covered in the research. |
| 4 | Clinical trials access | Not assessable | Not obtainable: not covered in the research. |
| 5 | Timely care — waits & surgical capacity | Not assessable | Not obtainable: not covered beyond the referral posture under Category 1. |
| 6 | Travel & transport support | Not assessable | Not obtainable: not covered in the research. |
| 7 | Workforce, navigation & support | Not assessable | Not obtainable: not covered in the research. |
| 8 | Research funding & representation | Not assessable | Not obtainable: register counts are published only for the concentration institutions and Atlantic provinces; Yukon's presence cannot be determined from them. |
Northwest Territories — Overall: Insufficient data — not graded (mean of assessed categories 1.0, based on 1 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 1 | Territorial screening, referral, and community-based supports with reliance on southern tertiary centres — services in operation without a consolidated strategy or agency-equivalent structure. |
| 2 | Biomarker & genetic testing | Not assessable | Not obtainable: the biomarker database has no entries for the Northwest Territories. |
| 3 | Drug coverage & patient costs | Not assessable | Not obtainable: not covered in the research. |
| 4 | Clinical trials access | Not assessable | Not obtainable: not covered in the research. |
| 5 | Timely care — waits & surgical capacity | Not assessable | Not obtainable: not covered beyond the referral posture under Category 1. |
| 6 | Travel & transport support | Not assessable | Not obtainable: not covered in the research. |
| 7 | Workforce, navigation & support | Not assessable | Not obtainable: not covered in the research. |
| 8 | Research funding & representation | Not assessable | Not obtainable: register counts are published only for the concentration institutions and Atlantic provinces; the territory's presence cannot be determined from them. |
Nunavut — Overall: Insufficient data — not graded (mean of assessed categories 1.0, based on 2 of 8 categories)
| # | Category | Score | Reason |
|---|---|---|---|
| 1 | Strategy & pancreatic focus | 0 | "No standalone cancer agency"; care runs by referral to southern tertiary centres, via referral pathways. |
| 2 | Biomarker & genetic testing | Not assessable | Not obtainable: the biomarker database has no entries for Nunavut. |
| 3 | Drug coverage & patient costs | Not assessable | Not obtainable: not covered in the research. |
| 4 | Clinical trials access | Not assessable | Not obtainable: not covered in the research. |
| 5 | Timely care — waits & surgical capacity | Not assessable | Not obtainable: not covered beyond the referral posture under Category 1. |
| 6 | Travel & transport support | 2 | Patient travel support programs "are significant line items" — a funded territorial program of significant budget scale. Its terms (lodging, prepayment, eligibility) are not in the research. |
| 7 | Workforce, navigation & support | Not assessable | Not obtainable: not covered in the research. |
| 8 | Research funding & representation | Not assessable | Not obtainable: register counts are published only for the concentration institutions and Atlantic provinces; Nunavut's presence cannot be determined from them. |
The territories publish as "Insufficient data — not graded" because the research itself was thin there — strategy posture only, with no biomarker records. That is a finding about the evidence base, and also the reality the grades describe: territorial patients are served entirely through referral to provincial systems.
4. Atlantic Canada in focus
Research funding
Of the 88 pancreatic-cancer grants in the CIHR register compiled for this research, totalling $23,354,337, six went to Atlantic institutions, totalling $273,000 — about 1.2% of the funding — all in Nova Scotia: five at Dalhousie University (including a $98,000 NK-cell precision immunotherapy project, a $105,000 doctoral award in pancreatic neuroendocrine tumour immunotherapy, and three $17,500 awards) and one at the Nova Scotia Health Authority ($17,500, on quality of care for pancreatic cancer patients in Nova Scotia). Newfoundland and Labrador, New Brunswick, and Prince Edward Island hosted none.
The Atlantic Cancer Consortium
The region's flagship research collaboration is the Atlantic Cancer Consortium, a four-province consortium operating within the Marathon of Hope Cancer Centres Network. Its funding is a single two-year pilot budget of $3.6 million (launched January 2021) that includes the Terry Fox Research Institute's $1.5 million contribution, with partners providing the approximately $2.1 million balance in matching cash and in-kind support. The consortium's demonstration projects target lung and colorectal cancer; the research found that it does not currently address pancreatic cancer-specific programs in a coordinated manner. The collaboration infrastructure itself — including its Patient Advisory Committee, with equal representation from all four provinces — was assessed as proven and extensible to pancreatic cancer.
Representation in national bodies
Atlantic Canada's presence in national decision-making is mixed, and in places stronger than the research first recorded. The Canadian Cancer Clinical Trials Network (3CTN) Management and Executive Committee is chaired by Dr. Ravi Ramjeesingh of Dalhousie University and includes Dr. John Thoms of Newfoundland and Labrador; the only 3CTN leadership roles with no Atlantic representation are the Scientific Director and Executive Director positions. The Canadian Partnership Against Cancer's board, as listed in October 2026, comprises 17 directors and two designated non-voting observers. The National Advisory Committee on Immunization (NACI) has three Atlantic-based voting members among its 16: Dr. Melissa Andrew (Dalhousie University, Halifax) and Dr. Tasha Ramsey (Nova Scotia Health, Halifax) for Nova Scotia, and Miranda O'Driscoll (Newfoundland and Labrador Department of Health and Community Services, St. John's) for Newfoundland and Labrador; New Brunswick and Prince Edward Island have none (Public Health Agency of Canada roster checked October 23, 2026). Across the 29 national initiatives the research assessed against the region's 6.8% population share, 15 sit above parity, 4 near parity, and 10 under-represented. The gap the research rated most significant is not a seat count but a closed door: the membership of Canada's Drug Agency's pCODR Expert Review Committee is not publicly disclosed, so Atlantic representation on the body that recommends cancer drug funding cannot be assessed at all.
The cost of take-home drugs
A 2021 PMPRB report estimated that private plans and cash payments accounted for 59% of 2019 spending on selected take-home oncology medicines in New Brunswick, Nova Scotia, and the combined PEI–Newfoundland and Labrador market, compared with 12% in Alberta. The PMPRB figure covers 47 selected take-home oncology medicines (oral and subcutaneous), and "private plans and cash" combines private insurance with cash payments; it is not an out-of-pocket percentage. A separate published source estimated average take-home cancer drug costs at $6,000 per month (CanCertainty, as cited in MacPhail & Snow 2022) — an estimate drawn from a budget proposal, not a measured average of what patients paid. Because the PMPRB publishes the Atlantic figures only as regional groupings (New Brunswick; Nova Scotia; PEI and Newfoundland and Labrador combined), no province-level cost figure exists for any Atlantic province, and this audit does not invent one: the four Atlantic Category 3 grades rest on the regional figure, as stated in each profile.
Travel and the rural burden
Atlantic Canada is Canada's most aged region, and much of its population is rural: the research records rural broadband access at 37% against 84% urban, more than 600 rural emergency department closures nationally in 2022–2023, and 62 First Nations communities across the four provinces. During the research period, pancreatic surgery sat in two cities and specialized diagnostics were limited outside them, so travel is not an add-on to treatment — it is a stage of it. Patients routinely receive services in a province different from their residence. The documented friction is consistent: reimbursement rather than prepayment, income thresholds that exclude many rural residents (Nova Scotia's $35,000 threshold is the clearest case), referral conditions, and ferry schedules that conflict with treatment appointments. Cash-flow stress for rural and Labrador patients travelling to St. John's is recorded as capable of delaying treatment starts. Since this research was completed, The Moncton Hospital completed Atlantic Canada's first robotic Whipple procedure (announced September 2026) — a third surgical city in the region, and a change this audit's grades, which score the research period, do not capture.
5. What the student researchers recommended
The recommendations below are the student researchers' own, drawn from their research documents. They are not foundation positions.
- Biomarker testing. Set a turnaround-time target of ten working days or fewer for biomarker results, and build an Atlantic coverage baseline using Quebec's INESSS/RQDM processes as a template.
- Drug coverage. Adopt take-home cancer drug coverage standards that close the gap with Alberta-level public funding (88%), treating take-home drug coverage and the fragmentation of provincial laboratory formulary systems as critical priorities.
- Federal transfers. Move the Canada Health Transfer toward age-adjusted allocation, which the reform strategy projected — as a projection, not an observed figure — could yield more than $200 million annually in additional funding for Atlantic health services.
- Travel support. Raise Nova Scotia's travel-assistance income threshold from $35,000 to $50,000 in gross family income, and work toward targets the researchers set: travel distance under 200 km for 90% of patients within three years, and 80% rural broadband coverage within three years.
- Collaboration. Extend tri-provincial collaboration models to include Newfoundland and Labrador, particularly for high-burden, low-survival cancers; integrate the Atlantic Clinical Trials Network with the consortium's patient advisory structures, which the researchers ranked the most impactful collaboration gap; and present the Atlantic Cancer Consortium and ACCESS Atlantic as national exemplars for regional collaboration.
- Workforce. Add oncology- and diagnostic-specific workforce targets to national and provincial policies, and build retention mechanisms that go beyond initial bonuses and debt forgiveness.
- Indigenous cancer care. Place Indigenous patient navigators in each province within eighteen months; mandate explicit cultural-safety standards consistently; and move Indigenous self-determination in cancer planning from partial support toward codified decision rights.
- Transparency. Publish the membership composition of the pCODR Expert Review Committee, the gap the advocacy analysis rated most significant.
6. Data gaps and limitations
This audit publishes what the research could support and states plainly what it could not.
Figures that could not be verified, and were not published:
- A claim in the research that Ontario's biomarker program was "operational since July 2025" could not be verified from any primary source and is not published. The verified record is the 2021 rollout described in Section 2.2.
- A claim that an Atlantic trials unit had "capacity spanning 30 to 50 clinical trials" could not be verified for any body and is dropped. The 45–55 trials in start-up and 20–25 active trials reported in Section 2.4 belong to the Atlantic Clinical Cancer Research Unit (Nova Scotia Health); a similar acronym (ACCRU) is also used by an unrelated American consortium, and no organization-published aggregate trial counts could be verified for either body.
- Nova Scotia's wait time appears in the student research as 56.7 weeks. That was Nova Scotia's figure in the 2023 edition of Waiting Your Turn; the 2024 figure, 39.1 weeks, is the one published here.
- One representation analysis stated in its narrative that 22 of 29 national initiatives were under-represented, a claim irreconcilable with its own data table. This audit publishes the table only: 15 above parity, 4 near parity, 10 under-represented.
Coverage gaps in the research:
- The territories have strategy posture only. The biomarker database has no entries for Yukon, the Northwest Territories, or Nunavut, and the narrative strategy synthesis covers the ten provinces only.
- Numeric wait times exist only for Prince Edward Island and Nova Scotia, from a single source, and measure all specialties. Pancreatic-specific wait times are not quantified anywhere in the research.
- Drug coverage detail is deep only for Ontario's programs. Atlantic drug costs rest on one regional figure from 2019 spending data — the most current the PMPRB publishes in that form, but dated.
- Prince Edward Island's workforce policy is not covered at the province level. Workforce evidence generally is policy-level, not headcounts.
- The CIHR register ends with November 2024 competitions, so the funding picture is the most dated element of the audit.
- One working draft in the research was undated and partly incomplete — its New Brunswick section was empty — and was treated as draft material throughout.
Judgment calls disclosed by the scoring pass:
- Category 5 (timely care). The rubric's declared simplification — surgical location is the primary anchor — was applied to Prince Edward Island. PEI's 77.4-week wait, the longest in Canada, is stated in its profile, but PEI scores 1, not 2, because it has no in-province pancreatic surgery.
- Category 4 (trials). Band 3's test, "multiple active trial sites," cannot be enumerated from the research for any province. Quebec's score of 3 rests on hub and concentration evidence (Montreal at 34% of recorded trial activity), while Nova Scotia was held at 2 — despite hosting the Atlantic research unit and the COMPASS Halifax site — because the research's own verdict is that pancreatic trial access in Atlantic Canada is "extremely limited."
- Category 6 (travel). Programs mentioned in the research without documented terms were not treated uniformly, because the evidence differed: Manitoba's bare mention of coordinated travel support was marked not assessable, while Nunavut's travel programs — documented as significant budget line items — scored 2.
Standing limitations. The underlying research is student work, in places unedited, and several source documents are undated; figures that appear only in the program's assignment briefs are worked examples, not findings, and were excluded from the evidence base. The representation research measures Atlantic representation only, which is why Category 8 rests on different evidence for Atlantic and non-Atlantic jurisdictions. This audit is a one-off snapshot of the 2025 research period; it is not a live measurement, and no re-grade is committed to at this time.
Sources
The audit's evidence base is the Policy Builders of Tomorrow research inventories (2025): the provincial cancer strategy database; the biomarker policy database; the provincial implementation, infrastructure, and transport matrices; the workforce, rural-access, and Indigenous cancer care assessments; the national representation database and analyses; and the CIHR funding register compiled by the researchers. Key figures were verified before publication against the following primary and published sources:
- Patented Medicine Prices Review Board (PMPRB), Alignment Among Public Formularies in Canada, Part 2: Oncology Medicines (May 2021) — Figure 3.3(b), 2019 spending data.
- Fraser Institute, Waiting Your Turn: Wait Times for Health Care in Canada (2024 edition; 2023 edition for the corrected Nova Scotia figure).
- Ontario Health / Cancer Care Ontario, Comprehensive Cancer Biomarker Testing Program; University Health Network implementation notice (2021); Ontario Health Annual Report 2021/22.
- Terry Fox Research Institute (TFRI), Atlantic Cancer Consortium pilot project record.
- Canadian Partnership Against Cancer, Board of Directors roster (accessed October 23, 2026).
- Public Health Agency of Canada, "NACI: Membership and representation" (accessed October 23, 2026).
- Canadian Cancer Clinical Trials Network (3CTN), governance roster.
- Canadian Institutes of Health Research, funding data (competitions to November 2024).
- Horizon Health Network, news release on the first robotic Whipple procedure at The Moncton Hospital (September 21, 2026).
- Health Canada, Canada–Newfoundland and Labrador Working Together bilateral agreement (signed March 25, 2024).
- MacPhail & Snow, Current Oncology (2022), citing a CanCertainty Coalition budget proposal.