Surely the true cost of a cancer drug is the quality of life it gives the patient
If a cancer drug extends your life by, say, two months, but does so with crippling side-effects, was it worth it?
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| The price of care: the NHS has to take hard decisions over what to fund Photo: GLOW WELLNESS/ ALAMY |
7:30AM BST 03 Oct 2011
9 CommentsRegardless of the prognosis, a diagnosis of cancer is a potent, emotive label that adds a fierce intensity to life. The imagery used is that of battle. As Susan Sontag discussed in her book Illness as Metaphor, the words we use to describe cancer are the words of war. The cells invade and we fight back. We have an arsenal of treatments to defeat cancer. Cancer is the enemy. For embattled patients and their families for whom standard chemotherapy has failed, is it right that they also have to battle the NHS to get the new, more expensive and potentially life-extending drugs they need?
It seems that every few months we read about another wonder drug that the National Institute for Health and Clinical Excellence (Nice), the government organisation responsible for evaluating clinical treatments, has refused to fund on the NHS. Is it right to put a price on someone’s life? To decide what is cost-effective and what is not?
Last week The Lancet published an article attempting to address just this. It was entitled “Delivering affordable cancer care in high-income countries” and was written by more than 30 world-renowned cancer specialists from Europe, the US and Australia. In it, they concluded that many of the most costly drugs used in treating advanced cancer brought little value and argued that, with an ageing population, difficult decisions had to be made.
It seems cold and callous to talk about cost and value when we are referring to people’s lives. More than 300,000 people are diagnosed with cancer in the UK every year and for each of those people and their families, it is devastating. I understand exactly how they feel.
Two months ago my gran was diagnosed with inoperable lung cancer. She was given three months to live. I can understand the burning, all consuming desire to extend a life at whatever cost. The wish to live just one more day can be limitless. How can anyone say that a few extra days with their loved one is not worth the cost? Well, in all honesty, I can.
The NHS spends £5 billion a year on cancer treatments, an increase of £2 billion since 2002. This is the cost. But when doctors talk about cost, they don’t mean the money. Certainly this concerns Nice, but built in to its cost-analysis is the quality of life that is gained. While the glossy marketing material might make attractive claims for new drugs, a closer inspection often shows a different story.
The NHS spends £5 billion a year on cancer treatments, an increase of £2 billion since 2002. This is the cost. But when doctors talk about cost, they don’t mean the money. Certainly this concerns Nice, but built in to its cost-analysis is the quality of life that is gained. While the glossy marketing material might make attractive claims for new drugs, a closer inspection often shows a different story.
Wading through the statistics and critically appraising the studies, it becomes clear that things are more complicated than they first appear. Some of the studies are not “statistically significant” – meaning that the results could be down to chance rather than an actual positive effect of the drug, so there’s no actual proof they work. But also, even if a drug extends your life by, say, two months, but does so with crippling side-effects, such as constant nausea and diarrhoea, was it worth it?
The cost here is not financial but physical and emotional. As the Lancet article says: “Patients should be spared toxic effects and false hope.” There are many people who would rather live a few weeks less but be able to get out of bed and make it to their daughter’s wedding, for example. Yet this reality is ignored. Where is the discussion about quality of life? If the quality of life that the drug provides is not worth living, this is its real cost.
The sad fact is that, often, new drugs aren’t good enough and, as difficult as it is, we sometimes just have to accept this. I say this as a relative of someone dying of cancer, as much as a doctor because, while we waste money on drugs that don’t work, resources are taken away from other interventions that really can help and this, I think, is the real tragedy.
A research paper published in The New England Journal of Medicine randomly allocated patients with lung cancer to either standard oncology care or this plus palliative care. Those receiving palliative care input lived on average two months longer. Compare this with erlotinib, a new drug for lung cancer, which at £1,400 a month, costs far, far more than palliative care. Nice initially refused to fund it because it was not felt to be cost-effective but later capitulated due to pressure. It extends life by about two months – the same as palliative care, but with side-effects that include diarrhoea, gastrointestinal bleeding, and appetite loss.
As a doctor I want my patient’s last few months of life to be enjoyable, dignified and comfortable.
This is what I want for my gran as well. Sometimes, medication isn’t the best way to achieve it.
http://www.telegraph.co.uk/health/8799431/Surely-the-true-cost-of-a-cancer-drug-is-the-quality-of-life-it-gives-the-patient.html
The cost here is not financial but physical and emotional. As the Lancet article says: “Patients should be spared toxic effects and false hope.” There are many people who would rather live a few weeks less but be able to get out of bed and make it to their daughter’s wedding, for example. Yet this reality is ignored. Where is the discussion about quality of life? If the quality of life that the drug provides is not worth living, this is its real cost.
The sad fact is that, often, new drugs aren’t good enough and, as difficult as it is, we sometimes just have to accept this. I say this as a relative of someone dying of cancer, as much as a doctor because, while we waste money on drugs that don’t work, resources are taken away from other interventions that really can help and this, I think, is the real tragedy.
A research paper published in The New England Journal of Medicine randomly allocated patients with lung cancer to either standard oncology care or this plus palliative care. Those receiving palliative care input lived on average two months longer. Compare this with erlotinib, a new drug for lung cancer, which at £1,400 a month, costs far, far more than palliative care. Nice initially refused to fund it because it was not felt to be cost-effective but later capitulated due to pressure. It extends life by about two months – the same as palliative care, but with side-effects that include diarrhoea, gastrointestinal bleeding, and appetite loss.
As a doctor I want my patient’s last few months of life to be enjoyable, dignified and comfortable.
This is what I want for my gran as well. Sometimes, medication isn’t the best way to achieve it.
http://www.telegraph.co.uk/health/8799431/Surely-the-true-cost-of-a-cancer-drug-is-the-quality-of-life-it-gives-the-patient.html
