Sarah Houlton
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At face value, the recent figures from Cancer Research UK on the survival rates of oncology patients seem like great news.
Almost half of British patients diagnosed from 2000 through 2001 are now expected to survive for a decade or more, compared
with about a quarter of those diagnosed in 1971. What's more, the figures show that oncology patients' five-year survival
rate is now nearly 50 percent. Yet a very different picture starts to emerge once you compare England with its neighbors.
From an already low base level, outcomes in cancer patients in the United Kingdom have fallen still further behind much of
the rest of Europe. Many believe this is due, in large part, to the country's attitude toward medicines.
To be sure, the situation concerning cancer drugs in the United Kingdom is twisted. The government's attitude seems to be
that oncology treatments are hugely expensive—and that too much of the National Health Service budget is vanishing into the
pockets of drug companies. Yet every time the National Institute for Clinical Excellence (NICE) advises against covering a
new oncology treatment, the media cry that local health authorities aren't paying for the drugs cancer patients need. In a
BBC survey, 180 oncologists said they were worried that important cancer drugs aren't being funded because NICE has claimed
they are not cost-effective.
"For every £100 the National Health Service spends, just £1 is spent on cancer medicines," claims Richard Barker, director
general of the Association of the British Pharmaceutical Industry.
John Melville, chief executive of Roche UK, agrees. "We spend somewhere on the order of £500 million in total on cancer medicines,"
he says. "But the debate might be more productive if there were more insight into the decisions we make. This is a question
of priority. In France, they spend three times per capita what we do in the United Kingdom. Surely it would be more constructive
to look at whether these medicines deliver value. Many countries believe they do, but it's not the case in the United Kingdom.
There is little difference in the incidence of cancer, in broad terms, across Europe, but cancer survival is very different."
Research bears this out. A report by scientists from Sweden's Karolinska Institute, published in the journal Annals of Oncology in May, says that both cancer survival rates and uptake of new medicines are far lower in the United Kingdom than in France,
Germany, Italy, and Spain. In these countries, more than half of cancer patients are receiving drugs that have been launched
since 1985; in the United Kingdom, that figure is just 40 percent.
Figures for some newer EU members are even more revealing. "The uptake in places like the Czech Republic and Hungary is better
than in the United Kingdom," says Barker. "You might think that these countries, which are getting their health systems together,
would not be able to afford the drugs, but that's not the case."
One way the United Kingdom is trying to improve cancer care is by setting up local cancer networks coordinating those involved
in diagnosis and treatment. There are now 30 networks across the country. However, these can lead to further inequalities
in treatment, depending on where patients live. "It's important we don't hide behind the generalities," says Melville. "There
are cancer networks that deliver care that's second to none, and there are others that do not."
Meanwhile, reports that NICE has been stalling on determining the effectiveness of expensive therapies abound. "There are
two types of drugs—those that have been through NICE and those that have not," explains Melville. "Those that have been through
the procedure have varied uptake. I can point to some areas where the uptake of Herceptin, which has been approved by NICE,
in eligible patients is as low as 20 percent. I don't buy the excuse we often hear of conservatism in UK prescribers. It's
very variable. At one end we have those who are on a par with the best of the world, and then those who are most politely
described as third world."
Sarah Houlton is Pharmaceutical Executive's global correspondent. She can be reached at sarah@owlmedia.co.uk
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