A new report questioning the cost and usefulness of many cancer drug treatments has drawn fire from regulators, industry and patient groups in the UK.
The report, produced by The Lancet Oncology Commission, calls for "a radical shift in cancer policy" in higher-income countries, where it says the cost of care is becoming unsustainable due to "an ageing global population and an endless conveyor belt of expensive new drugs and technologies" plus increasing financial pressures.
More than half of the $286 billion cost of the 12 million new cancer cases diagnosed worldwide in 2009 was related to treatment, and the number of new cases is expected to hit 22 million annually by 2030, says the Commission, which is led by Professor Richard Sullivan of the King's Health Partners Integrated Cancer Centre in London.
In the UK, spending on breast cancer has gone up about 10% in each of the last four years, and these increases have generally been driven by innovation, according to the report, which was presented at the European Mutidisciplinary Cancer Congress in Sweden.
While the number of cancer drugs available in the UK has risen from 35 in the 1970s to nearly 100, these drugs can be "exceedingly expensive," but "few treatments or tests are clear clinical winners, with many falling into the category of substantial cost for limited benefit," according to the authors.
"There has also been a tendency towards more defensive medical practice, a less informed regulatory system, and a declining degree of fairness to all patients with cancer," adds co-author Professor Arnie Purushotham, director of the King's Health Partners Integrated Cancer Centre.
The authors call for radical action to simplify and integrate patient treatment pathways and new models of care with lower cost bases, adding that “a whole new approach to expensive interventions - from mandatory cost-effective analysis, to the prohibition of off-label use and new economic models for reimbursement and incentivisation - must be driven through healthcare systems.”
Responding to the Commission’s findings, the National Institute for Health and Clinical Excellence (NICE) said that, rather than criticising organisations such as NICE for declining reimbursement on grounds of cost-effectiveness, clinicians and patient advocates "should start challenging pharmaceutical companies about the high prices they seek for products with modest benefits."
The sums spent on R&D have increased three times over the past two decades but, as judged by the number of drugs licensed per dollar of R&D, "the innovative performance of the drug industry has declined," write NICE chairman Professor Sir Michael Rawlins and Dr Kalipso Chalkidou, director of NICE International UK, in an editorial in The Lancet Oncology.
The Commission's report has also drawn particular fire for criticising the “futile” provision of expensive care to patients during the last weeks and months of their life. "In a large percentage of cases, such care is not only futile, but contrary to the goals and preferences of many patients and families if they were adequately informed of their options," it says.
But, says Stephen Whitehead, chief executive of the Association of the British pharmaceutical Industry (ABPI), "different people react in different ways to treatment, and medicines can actually add many years to a person's life, even when the expectation is that it will only lengthen life expectancy slightly."
To call palliative care treatment "futile" is "extremely unsympathetic and undermines each patient's person experience and desire to extend their lives," adds Duleep Allirajah, policy manager at Macmillan Cancer Support.
Palliative care costs are currently higher than necessary, and a key factor in the UK is the lack of 24/7 community nursing and unplanned emergency admissions, but providing this service as standard would lead to long-term savings and choice for patients, says Mr Allirajah.