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The media lapped up a report last week criticising the UK's record on cancer treatment. Rebecca Coombes unpicks the latest round of NICE bashing
When a report last week put the United Kingdom near the bottom of a league of developed nations for giving patients access to new cancer drugs, the press were more than happy to spread the bad news.
The drug company funded report from the Karolinska Institute, Stockholm, received a largely uncritical reception by UK newspapers, broadsheet and tabloids alike. “Cancer survival rates are worst in western Europe,” splashed the Daily Telegraph on its front page. The UK was the “sick man of Europe” for providing cancer drugs, said the Independent.
The report, paid for by Roche and published in the Annals of Oncology (volume 18, supplement 3, 2007), covers 25 countries, including Australia, Canada, New Zealand, South Africa, and the United States, as well as 19 European countries, and looks at access to 67 “innovative” cancer drugs. In its final verdict, the UK was yoked with Poland and the Czech Republic, as being “low and slow” in the uptake of new cancer drugs. The most stark “inequalities” in access to cancer treatment, according to the report, were for the new colorectal and lung cancer drugs, bevacizumab, cetuximab, eroltinib, and pemetrexed. In all cases UK uptake was said to be low or very low.
Access to these new drugs directly related to improved cancer survival rates, claimed co-author Bengt Jönsson, director of the Centre for Health Economics at the Stockholm School of Economics. “Our report highlights that in many countries new drugs are not reaching patients quickly enough and that this is having an adverse impact on patient survival. In the US we have found that the survival of cancer patients is significantly related to the introduction of new oncology drugs.”
The authors said that in France, Germany, Spain, and Italy 51-52% of patients had access to cancer drugs launched after 1985, whereas in the UK only 40% of patients had access to the 67 drugs listed in the report. The UK, according to the report, had the worst five year survival rate for all cancers of the five main EU nationals. France was top, with 71% for women and 53% for men surviving five years or more, and the UK bottom with 53% and 43% respectively.
The authors pointed the finger firmly at the National Institute for Health and Clinical Excellence (NICE): “Nowhere in the world is the decisive role played by economic evaluation more evident. It was the explicit objective of NICE to avoid any significant delays in bringing innovations to the market in the UK. There is as yet no evidence that this objective is met.”
The report, and the media coverage that followed, left NICE severely rattled. It said that the report was a “rehash” of a 2005 report by the same authors and that the update failed to acknowledge NICE's 18 month old rapid appraisal process, which fast tracks appraisals of new drugs in around six months. In a curt press statement, NICE chief executive Andrew Dillon said: “This drug industry sponsored report is flawed, inaccurate, and directly contradicts itself in places. It is the job of NICE to put the health of patients and the public first, not the profits of the pharmaceutical industry.”
Mr Dillon countered that NICE had sped up access to effective cancer treatments, with trastuzumab (Herceptin) being a case in point, and that use of NICE-recommended cancer drugs was now “higher than ever.”
From a public relations point of view, NICE associate director of external communications Lucy Betterton was not surprised that her organisation's battering from the Karolinska Institute went unchallenged by the UK media. For example, in the Daily Telegraph, consultant radiographer and breast cancer patient Sarah Burnett dismissed NICE as representing “yet another hurdle for the pharmaceutical industry to clear before a treatment is made generally available.”
Ms Betterton commented: “We weren't surprised by the coverage. Cancer is such a hot topic and stories like this are easy to run. It's a simple story—the UK has the worst access to cancer drugs and worst survival rates. Questions like, Where does the report come from? Who paid for it? What motivated them? are more complicated and not tackled often by the press.”
She said that new and expensive cancer drugs might not be any more effective than therapies already in use—a point not reflected in the Karolinska Institute report.
“We look at how well a drug works compared to other treatments and whether it is good value for money. One reason a drug may not be recommended is that it isn't sufficiently better than other drugs already available to make it cost effective for the NHS,” she said.
A lone supportive voice came in the Guardian from Tony Harrison, senior research fellow at healthcare think-tank the King's Fund. Mr Harrison said that Roche and other drug companies were “basically trying to destroy NICE.” Bringing in drugs as soon as they were licensed was not necessarily good for patients or the NHS, he said. “A proper assessment of clinical evidence on the ground—as opposed to a drug company's own trials—takes time.”
Richard Peto, professor of medical statistics and epidemiology at Oxford, told the BMJ that the report misrepresented the UK's success in bringing down death rates due to cancer.
He said mortality rates in the UK could not be compared with those in other countries. “We are so good at counting deaths in this country, whereas elsewhere there are underestimates.” Unlike in other countries, researchers were able to link into national mortality statistics and automatically be notified of cancer-related deaths.
Professor Peto strongly disagreed with the report's claim that access to the newest cancer drugs was the key to cutting cancer deaths. “The key determinant of cancer mortality is not the extent to which the latest drug is used—although there are a few exceptions, such as Herceptin. We are being strung along and new drugs are being developed that may work, but not very differently to the ones we already have.”
He said that the huge decreases in cancer mortality—he thought the best in the world currently—were largely because of a downturn in deaths caused by tobacco, and dramatically improved breast cancer survival ratesrates,, mostly attributed to the success of hormone therapies.
The Karolinska report warned that, as cancer research continued to grow, many new drugs and treatments would flood the market in coming years. “Countries urgently need to address how they are going to accommodate newer drugs into the healthcare systems and pay for them.”
But Professor Peto said that the real debate should be over drug company pricing. “Patient organisations may call for all effective treatment to be available for free, but if this was the case it would be exploited wholly by drug companies for corporate profit—they would double their prices overnight. The price rise in drugs has been unprecedented and is made more acceptable by reports like these. There is too much criticism of the NHS and not enough of these companies' pricing policies.”
A global comparison regarding patient access to cancer drugs. Annals of Oncology. doi:10.1093/annonc/mdm095-103. A summary is available at www.oxfordjournals.org/our_journals/annonc/press_releases/freepdf/mdm096.pdf