After much anticipation and delay, NHS England and the National Institute for Health and Care Excellence (NICE) have set out how they will tackle the thorny issue of getting more of the latest innovative life-extending drugs to advanced cancer patients quicker. This is their response to help the Government manage the financial pressures facing the NHS by securing better value for money from cancer treatment whilst maintaining a manifesto commitment to thousands of patients with advanced cancer that they will be able to get the best treatment for their disease, now and in the future.
The Cancer Drugs Fund (CDF) was only intended to be a ‘sticking plaster’ whilst government reviewed the process by which we assess innovative cancer treatments. It is clear that the financial management of the CDF has been less than perfect, but there is no doubt it has provided the only route for patients to receive internationally recognised standards of care, at a time when NICE didn’t recommend funding for the majority of cancer drugs it assessed over the last decade. Cancer is a devastating disease especially when it is advanced and patients are told it is terminal. The CDF allows treatments that can keep patients who are facing death the opportunity to live a few extra months, giving them a better quality of life and extra precious time with family and friends. What price do we put on this extra time?
The reforms outlined are long overdue. The big question for thousands of cancer patients at the heart of these new reforms is “Will I be able to get the same treatment in future that patients get now, or will it be worse?”
The reality is that many bowel cancer clinicians are worried that we are about to take a step backward in providing the accepted standard of treatment they need based on what we know works.
For all but the most determined opponents, it is clear that we are currently providing new cancer drugs based on what a patient wants and with a clinician deciding when a few more precious months of life is worth the cost. However, the NICE model that has initially rejected these drugs for funding is no longer a credible mechanism to determine access to cancer drugs, especially end of life drugs. How it appraises these treatments is lagging a decade behind innovation. We are at risk of moving backwards in the way we treat cancer with effective drugs disappearing forever. We have an analogue approach in a digital age.
Now we must build on the benefits of the CDF with a better, fairer approach.
The over inflated price of just a few drugs has dominated news headlines of late. Whilst I don’t defend the high price of a small number of new drugs, this focus is at the expense of established, cheaper treatments of proven worth. There are only a few treatments options left for advanced bowel cancer, some of which have been the standard of care for ten years or more. Nothing has changed in terms of their clinical effectiveness, but it is the way we decide whether they are still affordable that is the problem.
Health charities like the one I lead have been at the forefront of both highlighting the real-life benefits of access to new drugs and advocating for a new approach based on the real value of drugs to all patients. We need to hold pharmaceutical companies’ feet to the flame. If they believe in the value of their drugs then let’s seriously consider paying them by results. Companies could be asked to wait for the reimbursement until their drugs have been shown to work.
We have been deeply frustrated therefore when attempts to define how to assess that value have run into the ground time and time again. Something has to change. Recently bowel cancer doctors came together to warn of a return to the “dark ages” of cancer treatment. We cannot go back to a time of the original “postcode lottery” when patients in England were denied medicines that are routinely available in other parts of the UK and Europe.
It is time for politicians, ultimately the Prime Minister, to take charge. There is an assumption in some quarters that the evidence for denying these drugs is sound, fair and scientific. The reality is that we are on the brink of patients diagnosed with advanced bowel cancer in 2016 receiving worse treatment than those diagnosed in 2015. As they stand these proposals will erode the very welcome progress made due in recent years.
There is a huge prize here. Ultimately, we can be a centre of innovation in cancer treatments; leading the world in delivering new drugs faster to patients, with a robust, up-to-date system for assessing the value of these drugs. We should not return to a time when doctors had to tell patients their options have run out.
Mark Flannagan, Chief Executive, Beating Bowel Cancer