Friday, 20 November 2009

Is my cancer better than your cancer?

Of course not – what rubbish but if you read Karol Sikora’s article in the Daily Mail this morning A Stalinist NHS quango and British cancer victims denied drugs available in Europe you would think that was the case.

I won’t reprise the facts which you can get from his article but in summary NICE has refused to authorise the use of a drug called sorafenib to treat a particular kind of liver cancer. They say that it is too expensive for the extra months of life it can produce. The article explains this but it is worth repeating that “average three months” means that some people will not respond at all and die quite quickly (that happens in all cancers) and some will live for months if not a couple of years. This is unpredictable so they look at the average which is not unreasonable. The point that is made is that only about 700 people a year might benefit from the drug so the overall cost is, in health economic terms, not that high.

So far Karol and I are as one: then he goes off into “my cancer is better than your cancer” world. Several years ago a new breast cancer drug was launched – Herceptin. The results of the trials were startling and there was pressure to persuade government and NICE to fast-track this through. The consequence of this was not only that Herceptin was approved but that NICE changed its processes so that there could be a fast-track for other drugs under certain circumstances. Yes there was a campaign, yes there was a huge amount of press activity and I am sure that influenced government. Isn’t that good? Doesn’t that open the doors and point the way for other diseases to follow?

If we hadn’t had the two week urgent referral target for breast cancer would we now have it for all cancers? Would we have had the amount of media coverage for sorafenib, including families of patients who had been denied it speaking out if breast cancer campaigners hadn’t already shown how successful this could be?

A reality check: breast cancer is the MOST COMMON FORM of cancer. There are 45,500 new cases of breast cancer in women each year (and about 300 men). That is more than the number of men affected by prostate cancer (35,000), the number of men and women affected by bowel cancer (37,000) and lung cancer (39,000). It isn’t more important or a better cause than these cancers – it is more common.

Research has been successful and survival rates are improving but still 12,000 women (and about 90 men) die each year so we have a way to go. Breast cancer isn’t one disease – there are many breast cancers and we are getting more and more targeted treatments. What we really want to be able to do (in all cancers) is accurately predict which patient will respond to which combination of drugs – we are getting better but it is still a blunt tool and many millions would be saved (and unnecessary pain and suffering) by only giving drugs to patients who will respond - Breast Cancer Campaign is supporting this type of research.

There is a serious problem with the rarer cancers and it isn’t the amount of media publicity they get or whether or not drugs go through NICE. It is the amount of research that is done. We only have advances in treatments and understanding of causes/risks because of research and I recognise that because of the large number of people affected by breast cancer it is a fruitful area for research. NICE decisions sometimes make a mockery of research – what is the point of doing the research, which very often is funded by charities, unless the success is shared with patients.

So Karol and I might be not be so far apart until “Championed by a hugely powerful feminist lobby its (breast cancer) high profile is reflected in the large sums given to screening programmes, clinics, drug treatments and publicity campaigns”.

Karol you know better than that, let’s rewrite that in a factual way.

Championed by a huge number of women who suffer from breast cancer and families who have lost mothers, wives, daughters and sisters, breast cancer has a high profile. It is a disease which can be and is screened for. It has been responsible for the development of the multi-disciplinary clinical team to treat the disease more effectively. Through the adoption of successful research there is now a wider range of treatments for the disease and publicity campaigns aim to use every means available to educate women about the risk factors so that they can change their lives to reduce their risk and also the symptoms so that they can be treated early in the disease which will improve their chances of survival.

That sounds a bit dull I suppose – give me facts and dull every time.

P.S. Daily Mail online used a photo of the then Mayor of London, Ken Livingstone (remember him?) publicising our major fundraising event wear it pink for us. Note to Karol Sikora: politicians like posing for pictures with glamorous models because newspapers print them.......

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