Welcome to the first of a series of blogs on the subject of cancer nursing and related issues. I hope you find them interesting and a little bit provocative. I am also hoping that you will feel free to interact with me about the content…and anything else you feel is relevant. Are you sitting comfortably? Then let's begin.
One of the first actions of the coalition government when they assumed power last year was to set up a new Cancer Drugs Fund. This pledged £50m of additional funding to be spent on cancer drugs that 'their clinicians think they need'. This was swiftly followed by a further commitment to £200m per year for the same purpose. This funding falls outside of the usual cancer drug access provided by the NHS. This fund allows patients access to drugs that would not normally be available, but their doctors feel that access to them would offer benefit.
Now cancer doctors are not normally allowed to prescribe drugs that have not been officially sanctioned by the National Institute for Health and Clinical Excellence (NICE), as primary care trusts (PCTs) are not compelled to pay for unapproved drugs. This fund has changed all of that (although doctors have been allowed, and still can, make applications to PCTs for special funding on a one-off basis, many of which are turned down). So why has the government done this?
Cynics would point to the fact that, over recent years, the previous government had been regularly pilloried in the press for not allowing individuals or groups of patients access to drugs that may have benefited them on the basis they had not been approved by NICE. This culminated with the 2006 debacle surrounding Herceptin (trastuzumab), a drug that had remarkable efficacy in a particular genetic sub-type of breast cancer but that was unlicensed and unapproved by NICE in the UK. Many PCTs were taken to court by patients in order to access the drug. The government would, of course, be anxious to avoid comparisons with its predecessor in this regard.
There is a less cynical view which points to the fact that greater access to cancer drugs increases cancer survival. Recent studies suggest that, generally speaking, those countries that allow faster and widespread access to new treatments have higher survival rates. Although cancer survival rates across Europe are improving steadily there are differences, with France and Switzerland performing well. Both these countries provide the best access to new treatments.
There should be an element of caution sounded though. In a financial environment where NHS funding is expected to go further than ever, investment in new, sometimes unproven cancer drugs at the expense of other aspects of patient care may not be in the best interests of all patients. The coalition government has admitted that NICE will continue to have a vital role in assessing the efficacy of treatments.
There is a risk that aspects of care that are not drug-based are seen as somehow inferior. Good surgery remains the best chance of a cancer cure for many types of cancer, and radiotherapy is also as effective as drug treatment in many cases. In addition, as a nurse with a career in cancer care I am also keen to ensure that good nursing care continues to be invested in. Specialist cancer nurses are highly rated by patients and the input of all nurses throughout a patients cancer care is vital if patients are to feel cared for, rather than simply medicated. There also comes a point for many cancer patients where the drugs stop working and then other aspects of care have to present to ensure good continuing treatment and palliation.
To read Mark's second cancer expert blog, Reforming... and Performing, click here
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