Doctors in the UK are extremely concerned that the National Health Service will not be able to afford the new generation of cancer drugs coming onto the market.
Responding to a BBC questionnaire, 180 oncology specialists said they were worried or very worried by the present situation as many drugs are not being funded by the NHS because they fail to meet the cost-effective criteria set out by the National Institute for Health and Clinical Excellence.
There is also concern that patients may have to pay for more drugs themselves, and some of those who offer to do so are being told they would have to meet all their care costs, due to different interpretations of contracts and policies designed to separate private from NHS-funded care.
About half the drugs submitted to NICE are cancer treatments and they have had mixed fortunes. Roche/Genentech’s Herceptin (trastuzumab) finally got the green light to be used on the NHS after much heated debate but Tarceva (erlotnib) from OSI Pharmaceuticals and Roche has been turned down. The latest reversal for ImClone, Bristol-Myers Squibb and Merck KGaA’s Erbitux (cetuximab) came only yesterday as NICE rejected it as not being a cost-effective treatment for head and neck cancer, a decision that Merck is expected to appeal against.
Nick James, professor of clinical oncology at Birmingham University, told the BBC that the gap between what the NHS can pay for and what is actually available is going to get bigger. He said that “the drugs in the pipeline are going to cause even more pressure. I think politicians need to be honest and say this gap is going to be there and we need to look at ways of filling it". He believes it is inevitable that patients will have to make a bigger contribution to their treatments themselves, but is worried NHS policy stands in the way.
Cancer tsar says NHS is doing well but can improve
The BBC poll came out just as a government report was released by the National Cancer director for England, Professor Mike Richards. He said that the NHS must continue to change if it is to deliver better cancer care to patients, and while the system has improved, more reform is necessary. In the report, titled Getting it right for people with cancer, Prof Richards, dubbed the government's cancer tsar, claimed that treatment and care needs to be concentrated in specialist centres “so that clinicians with the right skills, experience and equipment are available to treat patients with complex needs safely."
He added that “medical technology is also making it possible to treat many patients closer to home; for example, simple chemotherapy is now given in district hospitals rather than specialist centres,” and some patients are receiving simple chemotherapy from nurses in outreach clinics, “meaning sick people don't have to travel for simple routine treatment". Prof Richards concluded by insisting that the needs of patients should be placed ahead of the convenience of the NHS.
Cancer Research UK welcomed the way in which the government is looking to tackle the problem but its medical director John Toy said that “we must not rest on our laurels if we are to meet today's and the future challenges of cancer and more closely match the US and Europe in terms of cancer survival.”
He added that the number of patients and the cost of diagnosing and treating them “will rise significantly during the next decade and beyond” and “as more sophisticated and expensive treatments will become available, it's essential that the NHS starts planning now for their introduction in the short to medium term."