Cancer Drugs Fund. Yes, but what about surgery and radiotherapy?

However, the quickness of the hand could well deceive the eye on the proposed Cancer Drugs Fund.

 

We’ve all seen the challenges as NICE fails to approve new cancer drugs. Individuals and families have to face up to making the best of what they have left and then suddenly find there’s going to be a lot less of it than they had thought because of rules, not the vagaries of cancer biology catching them out. Cancer drugs are a huge popular concern.

 

If you were bought up on the value of donating to cancer research – an idea that has existed for decades as a worthy charitable activity - you might be excused for wondering why you should bother if new treatments – a classic rhetorical device in fundrasing for cancer research - are then denied. Life lengthening drugs, even when that extension to life is measured in just weeks, may be very precious and a choice many would want to make.

 

The government has pledged to create a Cancer Drugs Fund to enable patients access to the cancer drugs their doctors think will help them, paid for using money saved by the NHS through their pledge to stop the rise in Employer National Insurance contributions from April 2011.

 

Whilst this is welcome news it will not, in fact, impinge on most cancer patients, since most people with cancer are not destined to become special ‘NICE’ cases. Few of the drugs NICE has not approved are for a common cancer.

 

However, this shows that rarer cancers actually need a different, more intelligent set of NICE rules. The question is how to ensure access to new drugs when rarer cancers face a structural problem that means they will never be able to enjoy economies of scale in drugs pricing.

 

By concentrating on cancer drugs it distracts attention from other major holes in current service provision that need addressing. It would be a pity if the constant search for news about new drug treatments sidelines interest in how well we are doing delivering new cancer treatment in other ways. Surgery and radiotherapy for instance.

 

Almost two thirds of people who have solid tumour cancers i.e. not cancers of the blood or lymph, are initially diagnosed and treated by surgeons and their multidisciplinary teams. Sometimes surgery is the only treatment needed but surgery is increasingly used in conjunction with other treatments like chemotherapy and radiotherapy.

 

Will there be policy developments that support surgical innovation and research - or take forward into widespread clinical practice developments such as laparascopic (key hole) surgery, or any of the ablative techniques such as cryotherapy, laser or ultrasound?

 

And then there are the hidden numbers of men and women over the age of 70 who seem to be denied standard evidence based treatments, on the grounds that their age ‘means’ they won’t benefit.

 

In reality there’s no assessment of these patients according to any standard protocol so, as over a third of new cancer diagnoses are in men and women aged 75 and over one can only wonder what on earth might be going on in that age group? How often is treatment denied or modified to a weaker offering with no evidence of how effective that modification might be? Research in breast and bowel cancer shows that carefully assessed and selected elderly people are much better able to put up with the rigours of treatment than you might expect.

 

What about some policy on age discrimination, to extend all treatment options free from an age bias?

 

And then there’s radiotherapy.

 

An audit of radiotherapy treatment was published in Clinical Oncology (2009) 21: 575-590 Radiotherapy in England in 2007: Modelled Demand and Audited Activity by M. V. Williams and K. J. Drinkwater. The audit “confirms the underprovision of radiotherapy in England and shows that it is largely accounted for by low access rates of 37% …..” “In consequence we estimate that 33 881 patients (13.9%) of the 243 748 patients diagnosed with cancer in England during 2006/2007 did not receive the radiotherapy we would have expected.” ….. “This will be essential for long-term planning as cancer incidence increases over the next decade, but it does not weaken the conclusion that there is a substantial current shortfall to be addressed immediately to improve timely access to treatment and thus the outcomes of therapy.”

 

Drinkwater and Williams had another go, on a similar theme auditing waiting times in Re-audit of Radiotherapy Waiting Times in the United Kingdom, 2007 for the Royal College of Radiologists. The results show that the percentage of patients waiting more than 28 days for radical radiotherapy dropped from 53% in 2005 to 32% in 2007. This is a significant benefit for patients but further improvement is required to meet this standard for all patients as originally recommended in 1993. So a third of patients are waiting more than 28 days for treatment to start – and the standard still has not been met, a decade and a half after it was defined.  

 

I wonder where the bulk of true costs of most cancer treatment lie and whether the Cancer Drugs Fund will only ever help a minority - a paragraph with one idea on cancer care rather than a chapter containing several. Will the Cancer Reform Strategy ever overcome inequalities of age and meet the service delivery expectations of the public across all cancer treatment, not just new drugs?