Too many of us know someone who has been diagnosed with cancer, or perhaps we have been affected ourselves. The statistics are worrying, as in our lifetimes half of us will be diagnosed with cancer and yet a third of cases are preventable. It is estimated that by 2030 four million people in the United Kingdom will be living with the disease1. Despite the advances in survival rates, there is still more to be done around prevention, earlier diagnosis and treatment. As Prime Minister Theresa May said during her speech at last year’s Conservative Party conference: “Every life saved means precious extra years with friends and family. Every life saved means a parent, a partner, a child, a godmother spared the pain of losing a loved one before their time2.” These words are a powerful reminder of the impact cancer can have and we share this focus on saving and improving the lives of those affected.
Currently a fifth of cancer patients are diagnosed in accident and emergency settings, resulting in worse outcomes3. The government and the NHS have recognised the need for change with a renewed emphasis on prevention, and the recently announced commitment to diagnose 75 per cent of cancers at stage one and two by 20284 is welcome. To support this, Pfizer operates a “whole patient approach” which means we are committed to being an active partner to the NHS, developing solutions to improve the delivery of care and outcomes for people with cancer. We believe that by working in partnership – combining skills, experiences and resources – we can tackle some of the challenges facing the NHS today, united by the common goal of putting patients first.
For example, we’re focusing on managing exposure to some of the causes of cancer – not just the cancer itself. We work with NHS England, on behalf of Greater Manchester Health and Social Care partnership, to reduce smoking rates for the local population. We are also providing an educational grant to enable the Velindre Cancer Centre in Cardiff to collaborate with IBM Watson and explore how innovative technologies, like artificial intelligence, could educate and facilitate lung and metastatic breast cancer patients to better manage their health throughout their cancer care.
We recognise that whilst the arrival of innovative medicines brings new hope for patients, sometimes they present challenges to the wider healthcare system through the disruption of established treatment pathways. Industry has an important role to play here, in partnership with the NHS and government, and together we can ensure our health system in its entirety is best set up to provide world-leading cancer care.
Treatment at the heart of the cancer pathway
Patients in the UK, though, will only be able to achieve the best results if there is improved access to innovative new medicines. This is why it is concerning that only 38 per cent of authorisations for highly innovative cancer medicines have received a positive recommendation from National Institute for Health and Care Excellence (NICE) from 2000 to 20165; and uptake of cancer medicines in the UK is slower than the European average6. The government’s introduction of the Cancer Drugs Fund (CDF) recognised the importance of new treatments7 and opened the door to greater access to some medicines for English cancer patients8.
However, the current Fund is significantly underspent, with just over half of its annual budget used by three quarters of the way through the financial year 2018-199. How cancer medicines are developed, assessed and used can be complex and it is increasingly important that the methods and processes for assessing them keep pace with scientific advances.
Combination therapies for cancer which offer targeted treatment options for specific tumour mutations are on the increase, but the system currently expects the combined price of all medicines to meet a single cost-effectiveness threshold. This means that new cancer medicines used in combination with other drugs can be rejected not due to the cost of the individual medicine but because of its use in a combination and this is an issue we must address.
Across all areas, from policy and services to research, rarer cancers are severely under represented and under-funded10.This results in delays and blockages for these patients, for whom the medicines appraisal system can also be particularly challenging5. Due to smaller patient populations it is often difficult to gather the data required by NICE’s value system10.
These approval problems mean patients do not reap the benefits of ground-breaking scientific research as early as our European neighbours. Without fundamental reform of how NICE assesses the value of medicines, we risk cancer outcomes slipping further behind our European counterparts. The upcoming review of NICE’s methods and processes later this year is a welcomed opportunity to get this right, and all parties – industry, government, the NHS and the patient and clinical community – should be involved.
Redefining living with cancer
As the NHS looks to the future, we share its ambition about what can be achieved for patients over the next decade and beyond. We are seeing exciting advancements in cutting-edge science that are transforming the lives of people living with cancer and the UK has the real potential to be a global leader in cancer care.
To achieve this, we need continued collaboration and a pro-innovation mindset across the whole system. At Pfizer, we recognise that neither the government nor the NHS can deliver on improvements on their own. We are clear that industry, government and the NHS must work together in a refreshed model of partnership to find solutions to ensure the system keeps up with the science. Together we can redefine living with cancer.
Olivia Ashman is Medical Director, Oncology at Pfizer UK.
Job code: May 2019 PP-ONC-GBR-0929
1 Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461160/ Accessed May 2019
2 Prime Minister, Speech: Our Future Is In Our Hands, 10 October 2018, Available at: https://press.conservatives.com/post/178695544270/prime-minister-our-futu… Accessed May 2019
3 Cancer Research UK, Percentage of Cases by Route to Diagnosis, Adults Aged 15-99, England, 2016. Available at: https://www.cancerresearchuk.org/sites/default/files/cstream-node/rtd_al… Accessed May 2019
4 Department for Health and Social Care, ‘Government announces plans for earlier diagnosis for cancer patients’, October 2018. Available at: https://www.gov.uk/government/news/government-announces-plans-for-earlie… Accessed May 2019
5 The Institute for Cancer Research, ‘From Patent to Patient: analysing access to innovative new cancer drugs’, December 2018. Available at: https://www.icr.ac.uk/news-archive/new-cancer-drugs-taking-longer-to-rea… Accessed May 2019
6 Jonsson, Bengt et al. IHE Report: Comparator Report on Patient Access to Cancer Medicines in Europe Revisited – a UK Perspective. Vol.1. 2017. Available at: https://www.abpi.org.uk/media/3459/report-access-cancer-medicines-in-eur… Accessed May 2019
7 Coalition Government, Policy Paper, ‘Equity and Excellence: Liberating the NHS’, July 2010, Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploa… Accessed May 2019
8 The Health Foundation, Unfinished Business: an assessment of the national approach to improving cancer services in England 1995–2015, November 2018. Available at: https://www.health.org.uk/sites/default/files/upload/publications/2018/U… Accessed May 2019
9 NHS England, Cancer Drugs Fund Activity Update, December 2018. Available at: https://www.england.nhs.uk/wpcontent/uploads/2018/01/cdf-activity-q3-18-… Accessed May 2019
10 Cancer52, Briefing Paper New Cancer Drugs Fund Operating Model, July 2016. Available at: https://docs.wixstatic.com/ugd/e22361_445829b2fa2e418db52133ded41ab07d.pdf Accessed May 2019