Cancer care: straining resources

James Gubb, 17 May 2007

A study released yesterday by Cancer Research UK revealed that in the past 30 years, survival rates from cancer in the UK have almost doubled from 23.6% in 1971, to 46.2% in 2000/1. OECD statistics running up to 2003 show the trend continued. In terms of deaths from cancer before the age of 70 that were potentially preventable by good medical care, the UK witnessed a 3.29% improvement.
Many, including the government’s cancer tsar, Prof Mike Richards, expect Eurocare-4 statistics, to be published later this year, to show further progress. A large proportion of the extra funds the NHS has received since 2000 has been targeted at improving cancer care through the NHS Cancer Plan; 99.9% of suspected cancer patients urgently referred by their GP are now seen by a specialist within 2 weeks, compared with just 63% in 1997; the number of cancer specialists employed by the NHS has increased by 49%; and £520m has been invested in new specialist equipment.
But a more interesting point will be to see whether improvements in the UK (assuming there will be improvements), outstrip those in other countries.

Some turn-around would be required here – between 2000 and 2003 OECD statistics revealed the UK actually fell significantly further behind a number of comparable countries, including Canada, Germany, Italy, Japan and the Netherlands. The fact is that despite the reforms and all the extra money, the UK remains behind other countries on key measures relating to cancer care.
Fergus Walsh, the BBC’s medical correspondent, has an interesting piece comparing the UK with France, asking ‘why France is so good at cancer care’ (France currently has the best survival rates from cancer in Europe). He highlights two aspects in particular: faster diagnosis and speed of treatment, and better access to drugs. In France there are 20 specialist cancer centres; France has 336 linear accelerators (used for radiotherapy) whereas the UK has 279; France has 3.4 doctors per 1,000 people whereas the UK has 2.3. The problem is recognised by Prof Richards, who is calling for a split between simple tests and treatments, which should be made closer to patients’ homes, and specialist cancer care to be concentrated in specialist centres. This would be a step in the right direction.
Yet the second issue is arguably even more acute. Dr Francois Pein, director of research at the Centre René Gauducheau highlights the irony: “You are world-leaders in developing new cancer medicines, yet patients in France get the new drugs denied to your patients’. A recent report by the Karolinska Institute in Sweden revealed how the UK lies close to the bottom out of 25 countries in terms of the availability of 67 new cancer drugs, along with Poland, the Czech Republic, South Africa and New Zealand. The report singled out the role of NICE as ‘leading to further delay for cancer patients in the UK getting access to new drug therapies’. Of course, all blame should not be heaped onto NICE. The real problem is one of cost – should the NHS, funded out of general taxation, be paying for expensive cancer drugs, such as Avastin, which costs £2000 per month and prolongs life by about 5 months? This poses huge ethical questions: a survey conducted by the BBC unsurprisingly revealed how 180 specialist cancer doctors are either ‘worried’ or ‘very worried’ about NHS cancer drug costs.
Yet this is part of a deeper problem. The BMA this week were honest enough to admit that a raft of health treatments will (probably) have to be rationed in the future because the NHS cannot cope with spiralling costs of new drugs and technologies, and unending patient demands. If cancer care in the UK is to be truly world-class, the government must urgently engage in a genuine debate about how such gaps are going to be filled and, more fundamentally, ask whether general taxation is the best way to be funding large parts of the NHS at all.