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New funding for cancer drugs

Fergus Walsh | 18:48 UK time, Tuesday, 27 July 2010

pillsOver the years I have done many stories about why cancer survival in the UK lags behind that of other EU countries. One trip to a regional cancer centre in France in 2007 sticks in my mind. I met patients being treated with drugs that would have been denied them in Britain. French cancer specialists were appalled by my stories of NHS rationing and told me that the cost of a new drug was irrelevant - if it was shown to be effective, then it was funded.

Today the cancer tsar Professor Sir Mike Richards published a report which, unsurprisingly, showed the UK lagging behind many other developed countries in its use of new cancer drugs.

In response the government announced a £50 million fund to pay for new cancer drugs in England. Professor Richards thinks it will help thousands of patients. It is a stop-gap measure until next April when a Cancer Drugs Fund comes into place. France has had a central funding system for years, which picks up the cost of expensive new cancer drugs so that they don't skew local health budgets.

Interestingly, today's report did not look at the effect of greater or lower drug usage on outcomes, such as survival rates. Professor Richards was keen to stress this point:

"Early diagnosis is the main factor in cancer survival, followed by good surgery, radiotherapy and cancer drugs. A lot of these new cancer medicines extend life for a few months, but those extra months are vital for the patients and their families."

So drugs alone make up a small part of the cancer treatment jigsaw. In 2007, France also had 20% more radiotherapy machines than the UK, and 50% more doctors per head of population. I'd be interested to know if those proportions have changed.

Recent years have seen improvements in cancer treatment, and many new facilities. One example is the £200m cancer centre at Barts Hospital in London which is aiming for a high proportion of patients taking part in clinical trials.

And outcomes are improving. Earlier this month, Cancer Research UK published figures showing that patients with breast, bowel and ovarian cancer, are twice as likely to live for 10 years, compared with the 1970s.

So will the new funding for cancer drugs be sufficient? A figure of £200m a year had been mooted but today that was described as an "aspirational" figure but could not be guaranteed. The government also denied that the cancer fund will undermine the work of NICE, the National Institute for Health and Clinical Excellence. It assesses new cancer drugs and comes in for huge amounts of flak when it turns them down as too costly. But the effect of the new fund will be that clinicians will have greater freedom to prescribe drugs, even if NICE has said no.

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  • 1. At 02:27am on 28 Jul 2010, danielcarter wrote:

    This comment has been referred for further consideration. Explain

  • 2. At 11:26am on 28 Jul 2010, sid_ts63 wrote:

    morning Fergus, the big piece of the jigsaw that you didn't mention of course is how patients react to a cancer diagnoses.the type of cancer I have has an average life expectancy of 5 years after treatment. I am just about to start on year 7. how have I managed to get there?
    luck, determination and a massive dose of being positive.
    luck, as the tumour I have is not an aggressive fast moving one
    determination ,I still have a lot to fit into my life and a lot to live for.
    masses of being positive,this being one of the biggest reasons. it costs very little but can have a massive effect IMHO
    what would help?
    once you have had your op and any treatment there is no organised rehab.
    a couple of decades ago there was no need for cancer rehab, not that many people survived . the treatments and the drugs available have moved on at a great pace the rehab and the support have not.

    I don't know how the system works in England ,the above is what I have found on my cancer journey in Scotland.

    Sid

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  • 3. At 11:52am on 28 Jul 2010, The Grammar Gestapo wrote:

    As someone who works for a PCT and has seen at close hand a lot of the often unfair and vitriolic flak that PCT's get when making rational decisions on cancer drug spending, I sincerely hope that PCTs are not asked to administer this fund, and that it is administered either regionally or nationally.

    Do the people welcoming this fund think that £50 million is going to give everybody everything they want? I very much doubt it will and so someone, somewhere is still going to have to say no if demand outstrips the amount of money available. I would predict that there is a lot of pent-up demand from people that PCTs have turned down, so in October are we going to see a mad rush of applications to this fund, and how quickly might it run out? Who then is going to turn people down on the grounds that the fund is empty, or is it going to keep being topped up at the expense of other vulnerable, but less vocal groups? I note that this £50 million was earmarked for free personal care for the elderly so already we are seeing the needs of the elderly being subjugated to the demands of a vocal, emotional, and at times irrational pressure group.

    The other question I have is who is going to take the clinical responsibility for the consequences of giving unapproved (potentially unlicensed) drugs? I would guess this would fall to the oncologists.

    I think that it is also very interesting to note that Lansley is ALREADY backing down on his headline-grabbing vote-seeking announcement of a £200 million fund, which is now being described as "aspirational". In simple terms, he made a pledge based on emotive headlines and now he's seen the potential costs of such an ill-advised pledge he's finding wriggle room to get out of it. Don't be surprised if the £50 million stays at £50 million next year.

    But what for me is the biggest sin of this story is that the experts are saying this will have no overall effect on cancer survival rates, so this can only be seen as a headline-grabber and not a policy for the long-term health benefits of the population.

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  • 4. At 12:37pm on 28 Jul 2010, David85wales wrote:

    Fergus fails to mention that pledges for extra spending on cancer drugs mean less money to spend on other drugs and treatments for other illnesses. The work that NICE does is vital to ensure fairness by rationing the limited resources available to the NHS (limited by our ability and willingness to pay taxes) in a transparent and logical manner so that drugs and treatments are assessed in a cost-benefit analysis style way. The alternative is special treatment for certain politically important diseases and substandard treatment for other less glamourous illnesses like mental health, heart disease, dementia, lung diseases etc. A special fund for cancer is a retrograde step that discriminates against sufferers of other diseases.

    The article also fails to mention that France can spend more on health because:
    1) Taxes are higher
    2) People pay a share of the cost of treatment or have additional private insurance to cover their share of the cost.

    We need NICE to ensure that there is consistency in rules about what to prescribe and when. Otherwise certain illnesses and groups with good lobbying power will get special treatment and that simply isn't fair.

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  • 5. At 12:38pm on 28 Jul 2010, John_from_Hendon wrote:

    If a patient needs cancer drugs the health service should be seen as already failing, particularly in the case of lifestyle related cancers. Would it not be better to get the earliest possible intervention by the NHS to prevent the potential patients getting cancer in the first place. Most cancer drug treatment is already, in part, failure.

    There are a number of known causal factor for certain types of cancer that are well known but, for most probably - commercial reasons, the campaigns against them are half-hearted - this must stop! If some activity is known to cause cancer it should be banned and the sale of products that are related to this activity should be banned - even it it costs the Treasury revenue.

    Having absorbed the above, the other matter that is important is changes to lifestyle that involve diet and exercise that are also important not only to everyone but also to diagnosed cancer suffers.

    Drug companies want to sell drugs - and do so by frightening patients with the fear of a painful and early death and the supposed 'cure' of their latest wonder elixir. We are all going to die. We all hope it will not be today. Most sane people try to avoid doing obviously dangerous things. The medical field must first let everyone know what is dangerous. Politicians must ban the sale dangerous substances. That should be the starting point - and not some unattainable nirvana.

    Drugs (and everything we put into our body is a drug!) need to be well understood and their interactions need to be understood. (That includes the food we eat and the air we breathe.) Holistic whole patient care should be the norm not the exception. There is a real risk that doctors see all patients as sick people. They should remember that life is a terminal illness. Their role is to make its passing and leaving as pain and discomfort free and as late as possible.

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  • 6. At 1:03pm on 28 Jul 2010, DisgustedOfMitcham2 wrote:

    I was going to write a response to this article, but I see I don't need to as U2034768 has already said everything I was going to say.

    Excellent post.

    Just to add that the French attitude, if Fergus has reported it accurately, is dangerously naive. Cost must be a factor in deciding when to use drugs. To argue otherwise is to pretend that the health service has an infinite budget.

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  • 7. At 3:05pm on 28 Jul 2010, sid_ts63 wrote:

    #5 John _from _ Hendon ,afternoon , 2 points to pick up from your post
    1. in the 7 years of my cancer journey I am yet to meet a specialist or anyone else for that matter who could explain what exactly I had done to trigger my Cancer and
    2. I wish you luck trying to ban booze, fags, mobile phones and fast food just for starters
    and then of course you could move on to dairy, red meat etc etc etc
    Sid

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  • 8. At 4:09pm on 28 Jul 2010, Dectora wrote:

    Fergus, while in France you probably didn't enquire whether or not record keeping in relation to cancer data was identical to that in the UK. It isn't, so comparisons are useless. The countries in the EU with the 'worst' cancer survival rates are, surprise, surprise, those with the fullest records. Denmark is one. In France it is possible for a death to be recorded as 'sudden death' as happened with the French mother of a friend who died from undiganosed metaticising cancer, in agony. her French GP insisted that she was merely 'feeling the heat'. @John from Hendon. Many cancers are genetic in origin and if you lead a life of pure virtue, but have inherited the mutated JAK2 Kinase,you could still end up dying horribly from Polycythemia Vera (for which there is no cure).

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  • 9. At 7:45pm on 28 Jul 2010, John_from_Hendon wrote:

    #7. sid_ts63 wrote:

    "I wish you luck trying to ban booze, fags, mobile phones and fast food just for starters and then of course you could move on to dairy, red meat etc etc etc
    Sid"

    Sid, just because something is hard does not mean we shouldn't try - we did get rid of lead from petrol. Your list is a good starting point and don't you find it shocking that we have known about these problems for half a century but have not done much?

    #8. Dectora wrote:

    "Many cancers are genetic in origin..."

    Yes, probably quite true, but does that mean that we, as a society, should accept that the cancers that are environmentally, diet or lifestyle caused should not be countered? We have to start somewhere and sid's list is a fine starting point!

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  • 10. At 8:08pm on 28 Jul 2010, sid_ts63 wrote:

    #9 john , evening, the problem of course is nothing to do with knowing or not knowing it is to do with big business being given a free hand to do what it likes while successive governments whether that was red or blue tory's took the taxes and left their pals to take the profits and didn't give a monkeys about the general public.
    what matters in 21 century Britain is business's make profits at all costs anything less is seen as failure.

    Sid

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  • 11. At 9:00pm on 28 Jul 2010, BluesBerry wrote:

    New funding for cancer drugs, or no funding (or even consideration) for cheaper drugs.
    Researchers at the University of Alberta in Edmonton, Canada, have reported a cheap and easy drug to produce that is able to cause tumor regression in lung, breast and brain tumor cells grown in culture and lung tumors grown in immunocompromised rats.
    The drug is called Dichloroacetate (DCA). It targets mitochondria (meaning an organelle in the cell that produces energy) and induces apoptosis (meaning cell death in tumor cells).
    It did not have any effects on normal, non-cancerous tissue......
    I remember reading about this & wondering: If a cure for cancer was discovered how much would big pharma lobby to keep the news away from the public? Afterall big pharma makes billions on the hope of cancer patients.
    There's little money in cure, only in prolonged treatment
    Then there are things like Vitamin B17. Why was it pullled from the market place?
    B17 is laetrile. A few decades ago, the big pharmaceutical companies lobbyied Congress & Congress made B17 illegal in the US. The Congress did not testing, asked no real questions?
    Laetrile is from the apricot pit. It would seem simple and cheap to me to assess the value of laetrile in cancer patients; so why wasn't this done?
    Sometimes, I think the Cancer Industry is just that: an industry that keeps growing and growing and making loads of money, and if a relatively cheap cure came along, it probably would get intentionally lost in the machinery.

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  • 12. At 9:56pm on 28 Jul 2010, sid_ts63 wrote:

    #11 bluesberry, good evening , where would I find out more about this? the problem as you point out is it may be a relatively cheap cure but it is also plant based and cannot therefore be patented not good news for big pharma but it maybe just what i was looking for. thank you , you have just made my night!
    Sid

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  • 13. At 1:03pm on 29 Jul 2010, DisgustedOfMitcham2 wrote:

    #11 & #12

    DCA is an interesting molecule, but the research you mention is only in the laboratory. Many drugs look promising in the laboratory, but subsequently turn out not to work in clinical trials in humans. My understanding is that human trials are currently ongoing, and it's too early to say whether or not it works. See here for more information.

    As for laetrile, it was pulled from the market place because it was toxic and didn't work.

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  • 14. At 10:52pm on 29 Jul 2010, sid_ts63 wrote:

    #13 DoM2,Evening ,thanks for the link. the fact that someone somewhere is actually doing research on my illness and have reached the human trials stage is heartening to say the least.
    Cheers ,Sid

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  • 15. At 4:17pm on 03 Aug 2010, Ben wrote:

    As a medical writer for the pharmaceutical industry, I come across nasty NICE stories almost daily. The fundamental problem is that there is a finite amount of funding and this can only be shifted one way or the other; where you put more into cancer drugs, you will lose in other areas. It's necessarily utilitarian - if you put more money into a cancer drug that extends life by 3 months then that could be taking money away from neo-natal wards, where babies have life expectancies measured in decades. No system - not value-based pricing or PPRS - will be able to rectify the funding problem: there's just never enough money to go around.

    Ultimately, and what seems to be forgotten in these debates, is that the pharma industry should lower its prices for new and innovative drugs, rather than set them at whatever price they desire and make the NHS pay through the nose for. That is what NICE is there for - it is a drugs' watchdog and helps hammer out better deals for the NHS with re-reimbursement schemes. The pharma industry spend billions on R&D (although this is falling) but does get a very, very healthy return on investment. It is the prices they sell drugs at to the UK which is the problem and £200 million, even if it was met, is a pitiful sum that will not even scratch the surface of what is required.

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  • 16. At 09:59am on 04 Aug 2010, John Ellis wrote:

    I find it strange that one of the most common plants on the planet is not being used to its full benifit. yes its that one cannabis... many of its compounds are already used to kill cancer. its cheap cheafull and easy to produce.... But we still look towards the most expensive of research compounds to fix an age old problem.

    Fergus open your eyes and read up on some medical stuff that will give people hope instead of spreading despair and fear....

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  • 17. At 08:41am on 05 Aug 2010, keelybeecroft wrote:

    Fergus,

    Your article is very interesting - My MUM has terminal cancer and our PCT has recently NOT givien approval for the drug Sunitinib my Mum desperately needs. Our only option left is radio targeted therapy'. We now have to put in a new application for radio targeted therapy which again could take 4-6 weeks with only a 50/50 chance of approval! If they do not approve this drug my Mum WILL have an early death.

    Of course our PCT's will get bad publicity as we have NOT been told why it has been turned down and what their process is. Our PCT's are playing god with people's lifes! My Mu has had one week of sick in 14 years of working. She has paid taxes all her life so why does my Mum deserve an early death?

    Can anyone help me? Or suggest how I can fight this decision?
    Thanks

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  • 18. At 2:39pm on 05 Aug 2010, sid_ts63 wrote:

    #17 Keelybeecroft, afternoon, if you have not already got in contact with your local McMillan nurses or any nurse specialists do so now!
    try to stay positive and never ever ask your mums specialists how long she has got.if things are that bad get in contact with the likes of cancer research and find out what trials are going on that your mum may be considered for.but most important of all stick together as a family and support each other.
    Sid.

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  • 19. At 10:14pm on 05 Aug 2010, John Ellis wrote:

    http://www.norml.org/index.cfm?Group_ID=8289

    Investigators from Complutense University in Madrid assessed the anti-tumor potential of THC and JWH-133, a non-psychotropic CB2 receptor-selective agonist, in the treatment of ErbB2-positive breast tumors – a highly aggressive form of breast cancer that is typically unresponsive to standard therapies.

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  • 20. At 02:51am on 07 Aug 2010, Jerry Amos wrote:

    By far the biggest way to cut cancer way down is to not get it in the first place. Refer to the professor Jane Plant, CBE, book "The No-Dairy Breast Cancer Prevention Program". Also read "The China Study" by T. Colin Campbell, "Eat to Live" by Dr. Joel Fuhrman, and a number of others. Essentially the "diseases of affluence" are directly related to "the diet of affluence", namely meat, dairy, eggs, ... Those books and several others give the statistics and science on why cancer, heart disease, high blood pressure, ... are very prevalent in the U.K., the U.S., and other affluent societies. Rural Chinese call breast cancer "rich woman's disease" for observational reasons, now backed up by research.

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  • 21. At 5:36pm on 09 Aug 2010, Verite wrote:

    I am a cancer patient who goes to ground every October. Why? Because friends are inundated with tacky 'pink' goodies they feel obliged to buy, to 'help' cancer patients.

    Could the BBC do something on how much of this money actually benefits cancer patients please? Last year I expressed my feeling with an article http://after-cancer.com/cancer-news-short-stories/tacky-cancer-gifts-get-my-goat/ which got me replies from all over the world, all agreeing.

    This year Macmillan has a tie-up with Boots. Macmillan has also got us volunteering on committees to help survivorship, and Boots is one of few places in UK where we can buy clinically-trialled products from French hospitals that actually help our side effects. UK hospitals aren't interested, but these products are one reason why French survive 4.5 years longer on average than we do after diagnosis.

    Full of enthusiasm I phone Macmillan. To find out that Boots are going to sell PINS (apparently Macmillan earn money from these). But when I ask why can't they sell pins AND mention the products - not interested. Helping cancer patients by providing information about products that are developed and prescribed for cancer patients in French hospitals isn't their scene.

    I would love to help do research on the 'pink bling' that drives me up the wall!

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  • 22. At 10:07am on 11 Aug 2010, Megan wrote:

    Verite - why not do something a bit more practical with your campaigning abilities and publicise these products which you believe will help with side effects of cancer?

    Probably of more use than grumbling about pink bling (I won't touch it either) - I just ran a 'Not a Race for Life' event at my last college, as I wanted to encourage male students as well as female ones to participate and give. Cancer Research were grumpy about that until they got the cheque!

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  • 23. At 12:04pm on 17 Aug 2010, Ernest T wrote:

    Dear Fergus - you ought to be aware that the cancer drugs fund is seen by many commissioners as a fund for drugs with not enough clinical evidence to support their use as cost-effective treatments, or (worse) no clinical evidence at all. Setting money aside for these drugs may well disadvantage non-cancer patients who might otherwise have got treatment.

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  • 24. At 10:24pm on 13 Sep 2010, samparada wrote:

    If NHS is managed well then a lot of wasteful expenses can be cut and more money can be diverted into more advanced Cancer research and drugs. A few months back doctors at Cardiff organized a fund raising event to help building an institute for breast cancer surgery, I think that was very creative. As our life spans grow longer and longer, more older people will be diagnosed with cancer. We need to treat cancer at an early level as later stages require more elaborate and expensive treatment.

    - Sam

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  • 25. At 1:29pm on 30 Sep 2010, chezza100 wrote:

    4 years ago my Dad had stomach cancer with a 3% survival rate. Its great he is still here and relatively healthy.

    Now my mum has cancer of the neck and lymph gland and is going through gruelling Radio & Chemo theropy.

    Cancer is far too widespread now and nobody has been able to pinpoint the actual causes so until they do I think more funds need to be put into drugs to treat it and make survival rates much better.









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  • 26. At 12:37pm on 01 Oct 2010, Lewis Fitzroy wrote:

    "Cancer is a growing probelm in all age groups" Why is this happening ? New drugs have helped extent life, for a few people, depends on what type you have. but after years of trying to find a cure. and countless millions spent around the world {Where is it} ???? I have lost too many good friends because of cancer.

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