Therapy has scientists talking of cancer ‘cure’

Britain lags behind other countries in its use of modern treatments to combat the disease

A LEADING cancer specialist says scientists are starting to talk about using the word “cure” for the disease as immunotherapy treatments are starting to make a real difference for sufferers.

Speaking at Hay Festival, Dr Rebecca Kristeleit, clinical senior lecturer and consultant medical oncologist at University College London Hospital, said: “We have now got a number of molecular therapies which are benefit- ing patients substantially and improving their lives substantially.

“We are beginning to start thinking about using that word ‘cure.’ As an oncologist, it’s not a word that you would ever say because we talk a lot about being ‘in remission’ but ‘cure’ is the holy grail.

“With some of the immunotherapies, some patients appear just to go on and on with no resurgence of the disease.”

This is a worrying time for anyone newly diagnosed with cancer. The Cancer Drugs Fund is being wound up, after its budget soared from £175 million to £416 million in five years, leaving urgent questions over the future of cancer care in England – and thousands of patients wondering what happens next.

From this month, the National Institute of Health and Care Excellence (Nice) is to begin reviewing the 31 treatments currently available under the Fund, arousing fears that NHS patients will be denied access to cutting-edge treatments on grounds of cost. Nice, which assesses new medicines for use on the NHS, rejects about 15 per cent. But in the case of cancer drugs, with their greater costs – often exceeding £60,000 per patient per year – the refusal rate has traditionally been higher, at more than 30 per cent. This, say critics, is effectively sending cancer patients to an early grave. The Cancer Drugs Fund, with a separate budget to pay for these expensive drugs, where they were recommended by a cancer specialist, was established to take the heat out of these disputes. However, in bypassing Nice, it bypassed the principles of fairness and value for money on which Nice was founded. Now ministers have been forced to axe it.

We have known for more than a decade that cancer care in England compares poorly with other European countries. Our outcomes are worse and our death rates are higher due at least partly to our slow take-up of modern cancer medicines. But are we getting good value from the money we do spend on cancer drugs?

No, according to a recent paper by Professor Elias Mossialos and Sebastian Salas-Vega from the Institute of Global Health Innovation and the London School of Economics. It contains some surprising findings. In 2014, the UK prescribed more cancer drugs per patient than almost all the other eight countries studied – the US, Canada, Sweden, France, Germany, Italy, Japan and Australia. But the UK prescribed fewer new drugs, confirming the perception that we lag behind in our use of modern treatments.

Yet British spending on cancer drugs, at $32,600 per case, was significantly outspent only by Italy ($44,000 per case) and the US ($74,000). The picture of the UK as the poor man of Europe in cancer spending does not hold water. We choose, instead, to spend NHS resources differently.

Differently, but not well. On the question of value for money, the authors calculated on the basis of years of life gained that the UK lags behind France, Germany and Japan. Japan derived the greatest benefit per patient – more than twice as much as the US and more than three times as much as the UK.

With increasingly sophisticated, personalised treatments in development, the cost of cancer care is certain to rise, putting a huge and growing burden on the NHS budget. Andrew Dillon, chief executive of Nice, has warned drug companies against overcharging the NHS, and said some high-priced drugs have only marginal value.

Improving the value we get from spending on cancer drugs is vital. Any move by governments to restrict spending is almost guaranteed to provoke powerful protests. But there are measures we can take.

We should begin by setting common standards. The American Society for Clinical Oncology has led the way by defining a minimum 25 per cent improvement in survival in four patient populations as the standard for the adoption of a new drug. We should also examine how Japan manages to be so successful in obtaining value from its cancer drug spending.

Next we need accurate data on costs and benefits to compare different treatments. Data on outcomes is already widely available through cancer registries, many of which are hosted by governments, which have contributed to huge advances in understanding. Now we need to move to the next stage, systematically tracking the costs and benefits of therapies. Only governments can provide comprehensive data from impartial resources, which is essential for proper debate.

Governments can also purchase drugs strategically, by collecting refunds from pharmaceutical companies whose drugs fail to benefit individual patients, as happens already with a number of expensive medicines in the UK. Or we could follow the lead of New Zealand and British Columbia, where citizens’ juries have been used to decide the allocation of cancer spending.

These and similar initiatives will be vital as the world confronts a global bill for cancer care projected to rise from $290 billion in 2010 to $458 billion by 2030, even as evidence grows that higher spending at the population level is not improving outcomes.

There are difficult choices ahead. But the human and financial cost will be even greater if we fail to make them.

Lord Darzi is director of the Institute of Global Health Innovation at Imperial College London