Cancer drug uptake 'blocked by local NHS'

"Stinking black holes" - NHS primary care trusts (PCTs) that refuse to fund new cancer drugs - are distorting survival chances for patients around the country, according to a professor of oncology.

Professor Jonathan Waxman told the Westminster Health Forum on cancer today that the policy of devolving decision-making and budgets to local NHS organisations was a "tremendous waste of public resources".

"Local autonomy is extremely bureaucratic, a profligate waste of resources, prejudices patient survival and requires radical reform," he said. He gave the example of sunitinib, a drug for kidney cancer. The percentage of appeals for this drug approved by PCTs ranged from 0% to 100%.

Professor Waxman warned that drug companies were considering not applying for licenses for their drugs in the UK, which represents a small part of the global market. Mark Simmonds, shadow minister for health, said the Conservatives wanted to speed up access to drugs. However, Mike Richards, the national cancer director, warned that many of the drugs were of limited cost effectiveness and that tough decisions would need to be made.

Variation   

The second annual report of the Cancer Reform Strategy - the government's programme for delivering improved outcomes for patients - exposed significant variation in the provision of services in England. The National Colorectal Cancer Audit shows that while around 60% of patients undergo a major resection this varies from around 20% to 80% across the regions. 

The variation extends to survival rates. Breast cancer patients in Tower Hamlets have a 89.3% chance of surviving for one year compared to 99% in Torbay. The variation is even more marked in lung cancer (between 15.4% in Herefordshire and 43.7% in Kensington and Chelsea).

Fiona Harris, head of strategy and development for Bupa UK Health and Wellness, told Health Insurance that a key advantage of private cancer care was "there is no concern for you about where you live." She cited Avastin, a chemotherapy treatment (costing about £60,000 a year), as an example of a treatment not routinely available on the NHS (for metastatic or secondary cancer) but funded by Bupa. The insurer will also pay for treatment by Cyberknife, a  form of cancer therapy that precisely targets inoperable tumours.

New technology

Representatives of the private healthcare industry raised concerns at the conference about the "hurdles" to adoption of new technology by the NHS. For example, while there are two Cyberknifes in the UK there are 300 in the US.

Bettina Fitt, general manager, UK & Ireland for GE Healthcare, a private provider of healthcare, said the uptake of digital mammography for breast screening had been "very slow", a concern shared by Professor Richards.

"We have to break down this mentality of us and them [the private and public sector]," she said. "We can be part of the solution."

Spire Healthcare's clinical director Dr JJ de Gorter pointed out that the private sector is already helping to increase radiotherapy capacity in the NHS.

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