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Many jobs in New Brunswick involve regular exposure to carcinogens. While it is difficult—and in many cases impossible—to prove a case of cancer was caused by exposure to workplace carcinogens, some occupations are highly correlated with certain types of cancer. But until fairly recently, few occupational cancer cases qualified for Workers Compensation coverage.

Firefighters have long waged a battle to prove that their jobs put them at an increased risk for certain types of cancer and to have their cancer cases acknowledged as workplace injuries. Provincial governments across Canada are finally responding.

In 2009, the precedent-setting Firefighters Compensation Act granted New Brunswick firefighters presumptive coverage for certain types of cancer. In other words, firefighters with select types of cancer are no longer required to prove their disease is work related in order to qualify for Workers’ Compensation.

While this is good news for firefighters, insurers and payors had little data available to help them predict the cost implications of these legislative changes.

Morneau Shepell Inc. commissioned researchers from the New Brunswick Institute for Research, Data and Training (NB-IRDT) to assess the cost of health care for cases of occupational cancer that currently fall under NB Workers’ Compensation legislation and others that have been suggested for expanded coverage.

Cancers covered by presumptive legislation

• Bladder
• Brain
• Colon
• Kidney
• Leukemia
• Lung
• Non-Hodgkin’s lymphoma
• Oesophageal
• Rectum
• Testicular
• Ureter

Cancers proposed for expanded coverage

• Breast
• Prostate
• Skin
• Multiple Myeloma

Researchers from NB-IRDT used the most recent pseudonymized administrative health data (2008-2013) available through NB-IRDT to identify cancer patients (including stage of cancer at diagnosis and age group) and to estimate the cost and frequency of acute inpatient hospitalizations for patients in treatment and terminal phases of care.

Using data from the New Brunswick Provincial Cancer Registry, the New Brunswick Discharge Abstract Database, and other cancer data repositories and fee schedules from across Canada, Dr. Ted McDonald, Margaret Holland, Adele Balram, and Jonathan Boudreau observed the following:

• the expected cost of acute inpatient hospitalization was substantial, ranging from $11,360 for stage III prostate cancer to $68,606 for brain cancer
• costs varied by cancer site, stage of disease, phase of care, and age group, with the mean cost being higher for:
  • older patients
  • patients diagnosed at advanced stages of the disease
  • patients in the terminal phase of care
• the most common cases of cancer were breast, prostate, lung, colon, and skin, which together comprised 66% of the total number of incident cancers
• rates of new cases of cancer in New Brunswick increased with age.

While the cost estimates developed by NB-IRDT can be used to better understand the future cost burden of presumptive legislation to the Workers’ Compensation system, they are by no means comprehensive. NB-IDRT cost estimates are derived from hospital-based services only. Cancer patients typically require treatments and supportive care services that occur in outpatient and community settings—components that are estimated to drive a large portion of cancer care costs and for which administrative data are not available.

As important as it is to understand the health care costs associated with cases of occupational cancer, it is even more critical to understand the extent to which New Brunswickers are exposed to carcinogens in the workplace. Because data about carcinogen exposure in New Brunswick workplaces stems primarily from clinical trials, there is a lack of administrative data on the subject, making it difficult to provide population-level estimates of carcinogen exposure in the province.

Access to this information is essential if New Brunswick is to improve the cost estimates of the occupational cancer burden and, even more importantly, if the province is to develop targeted and effective cancer screening and intervention strategies.

See the full report.

Report citation: Holland, M., Balram, A., Boudreau, J., & McDonald, T. (2018). The cost of occupational cancer in New Brunswick. Fredericton, NB: New Brunswick Institute for Research, Data and Training.