Can you put a price on quality of life?
"If there's a treatment that may extend your life by up to three months, costs, for example, £2000 per month (i.e. unaffordable for most), but is not available on the NHS, would you want me to tell you about it?"
This is the question posed by a cancer specialist to iPM listeners. It's a dilemma she's increasingly facing.
Both Labour and the Conservatives say the health budget will be protected from spending cuts, but the NHS could face more difficult choices with a new and increasingly expensive drugs market.
In recent years there's been improvements to so-called modifier drugs for terminally ill patients - the pills won't cure you, but they may extend your life.
But the cost is huge. While the National Institute for Clinical Excellence - NICE - gives guidance on which drugs primary care trusts should offer, trusts interpret the advice differently and make their own decisions about which drugs to fund.
We invited our cancer specialist to explain her situation
Listener Sheela Rao experienced the drug funding dilemma from the other side of the doctors' desk. Her husband was diagnosed with motor neurone disease in March 2000. His doctor said there was a drug that MAY help, but it wasn't funded by their trust. She starts by explaining how she felt the moment she was told.
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As a retired cancer specialist I was disappointed by the inability of you cancer specialist to coherently express the role of the doctor in managing end of life issues. Mrs Rao clearly realised at the end of her battles with bureaucracy that quality is paramount over length of life. It is the duty of clinicians to cure sometimes, reassure often and comfort always; the extension of life by expensive drugs with manifold side-effects is in my thirty year experience a painful and profitless, save for the drug companies, endeavour representing the triumph of hope over judgement. We do well to remember that no life is ever saved by any treatment, just the cause of death on the death certificate changes. Many of these treament will be benefit one in twenty patients which means that 19 in twenty will suffer unpleasant side effects in their final months. Clinical judgement once common is rare due to shortened training and will be rarer due to MTAS and EWTD.
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Thanks Maddoc55
To be fair to our specialist, she was communicating her concern about one aspect of her job rather than how she deals with her patients as a whole. Also patients are asking about drugs they've read about online which, as you say, may benefit one in twenty people, but which she has to advise patients on - patients who are often desperately searching for something to help them.
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Hi, listened to the podcast and I can't help feeling that I would rather not know about expensive treatments that might prolong my life for a few months. In fact I would rather avoid unnecessary interventions altogether.
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