Cost of treating cancer too prohibitive

Cost of treating cancer too prohibitive
We need to move beyond fighting over expensive drugs that add only a few months to life
by Karol Sikora 04:46 AM Sep 30, 2011
One in three of the population will be diagnosed with cancer at some point in their lives. Nearly all families have been affected. It is a disease that causes much emotion and fear.

Much of the technology is changing so fast that it has become a very challenging field for clinicians at the frontline. And patients are often left bewildered and frightened by the discrepancy between what is being offered to them and what they read and can find on the Internet.
This week's report from The Lancet Oncology Commission on the cost of cancer care in high-income countries, written by a series of experts, patient advocates and economists, provides a stark conclusion. Quite simply, no healthcare system can afford to pay for the huge increases involved in prolonging cancer patients' lives for a few weeks. We are truly at a crossroads.
The fact that the populations of the Western world are ageing, together with our increasingly unhealthy lifestyles, is dramatically increasing the incidence of cancer. The cost of the new technology to deal with this could be staggering.
The last eight drugs approved this summer by the US Food and Drug Administration will cost an average of nearly £10,000 (S$ 20,191) a month per patient - and that's not counting the cost of their administration or treating their side effects. This is a new level of expenditure for little overall gain: Between two and seven months' life, depending on the drug.
Sixty-five per cent of all cancer drugs are sold in one country that is home to less than 5 per cent of the world's population. Yet now even the US is baulking at the high cost of the new cancer drugs. Dendreon shares plummeted from US$40 (S$52) to US$10 this summer when Provenge, its vaccine for prostate cancer, simply wasn't selling because of its high cost. Until we can get regulators, payers and providers of care together with those that make and sell the drugs, it's going to be difficult to move on.
Over the last decade, an increasing number of cancer drugs have been licensed. Over 40 are now in the final stages of the global development pipeline. These are the products of the molecular revolution triggered by the discovery of the structure of DNA in Cambridge in 1953. They work by targeting the molecular cogs of growth control that go wrong in cancer. This is an exciting time for those involved in cancer research and care.
But the cost of getting a single drug to market now exceeds £700 million per compound. More sophisticated molecular diagnostics are also being developed to personalise care and increase its cost-effectiveness. Giving the right medicine to the right patient will drastically reduce the overall costs of care, but we are not there yet. Molecular signatures of response to high cost drugs that are easily determined by looking at a sample of a patient's tumour are urgently needed.
Within the next five years, clinical trials will look very different to today. Only patients whose cancers display the relevant biomarker pattern that suggests responsiveness to a new drug will be entered. After 24 hours of drug administration, we will be able to measure signals of response.
And there is much else to do to improve cancer survival. Radiotherapy has, until recently, been the Cinderella of cancer, yet more than 50 per cent of patients will benefit from it. The precision of dose delivery has been revolutionised by massive improvements in imaging and computerisation.
Earlier diagnosis, public education and prevention can be effective tools in saving lives. Palliative and end-of-life care are vital to support patients and an essential part of modern cancer technology. But what we spend on drugs we don't have for other strategies.
As doctors, we are the servants of society. We all have to face the difficult decision of how to ration healthcare together. It can never be a bottomless pit. If we spend more on cancer, then other patients will suffer. Mental handicap, chronic mobility disorders, dementia and the chronic care of older people with multiple illnesses are all deserving recipients of our health funds.
Society has to decide how much to put on the price of life. Doing whatever it takes to extend life by a few weeks is not a logical decision. Seeking solutions through better diagnostics and creating a policy that reflects the value of an extended life to an individual is challenging but likely to be the best way forward.
That to me is the essence of this report. THE DAILY TELEGRAPH

Professor Karol Sikora is medical director of CancerPartnersUK and one of the 37 authors of the Lancet Oncology Commission report published this week. This is excerpted from a longer commentary.
http://www.todayonline.com/Health/EDC110930-0000252/Cost-of-treating-cancer-too-prohibitive
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