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Britain is sick man of Europe for providing cancer drugs

By Jeremy Laurance, Health Editor

Published: 10 May 2007

British patients are being denied access to life-saving cancer drugs that are widely available in the rest of Europe and the developed world, according to a report.

The NHS's "penny-pinching" attitude to new treatments and "excessive bureaucracy" surrounding their assessment is condemning cancer sufferers in Britain to an early death, it says.

A review of the availability of 67 new cancer drugs in 25 countries has found that Britain languishes close to the bottom of the league. along with Poland, the Czech Republic, South Africa and New Zealand.

The authors, from the Karolinska Institute in Sweden, say research in the US, which has the highest use of new cancer drugs, has shown that new treatments have significantly increased the chances of surviving cancer.

A separate study of 20 countries showed that nearly a third of the improvement in cancer survival between 1995 and 2003 could be attributed to new drugs.

In Europe, the UK has the lowest survival rates and the lowest use of new drugs compared with the major Western countries of France, Spain, Germany and Italy. In all four countries, more than half of cancer patients were being treated with drugs launched since 1985, but in the UK only 40 per cent were.

The report, funded by the Swiss pharmaceutical manufacturer Roche, is an update of an earlier review published two years ago. Although Roche had no control of the report or its findings, the conclusions will help the drugs industry highlight inequalities in access to cancer drugs and so widen its market.

Paying for the new drugs, which cost up to £100,000 a year per patient, is putting pressure on health budgets in all countries. After decades in which little progress was made against cancer, new products have started to flood on to the market providing patients and health systems with difficult choices.

Austria, France, Switzerland and the United States top the league for the most widespread use of new drugs. The bowel cancer drug Avastin (bevacizumab) and the lung cancer drug Tarceva (erlotinib) are used 10 times more in the US than in Europe. Italy and the UK had among the lowest levels of use of Avastin and the UK was among the lowest for Tarceva. The study looked at the availability of drugs over 10 years from 1995 to 2005.

Nils Wilking, clinical oncologist at the Karolinska Institute and joint author of the report, published as a supplement to Annals of Oncology, said: " Progress in medical treatments has meant that more than half of patients diagnosed with cancer will now be cured or die from other causes. However, these benefits are only realised once the drugs get to the patients. Our report highlights that in many countries new drugs are not reaching patients quickly enough and this is having an adverse impact on patient survival."

The report singles out the UK for criticism, focusing chiefly on its bureaucracy. "Nowhere in the world is the decisive role played by economic evaluation more evident," it says, referring to the role of the National Institute for Clinical Excellence, the government watchdog which reviews new treatments.

It says Nice lacks the capacity to cope with its growing workload and criticises the Government for failing to reduce the delays.

"This leads to further delay for cancer patients in the UK getting access to new drug therapies and this is clearly demonstrated by the comparison of the UK with other countries studied in the report," it says. The Department of Health said "good progress" was being made in ensuring patients had access to cancer drugs and the process of Nice appraisal had been speeded up.

A report by the cancer tsar, Mike Richards, last year showed use of new drugs in the UK had increased. "We have reiterated in recent guidance that the NHS should not withhold funding for treatments just because Nice guidance is not available," a spokesman said.

John Quance, fireman, 57: 'NHS won't pay for the drugs to save my life'

A 57-year-old former fireman has been told he cannot have the drug his oncologist has recommended for his cancer because the NHS will not pay for it.

John Quance, who has been diagnosed with kidney cancer, has cashed in his pension and re-mortgaged his house to pay privately for the drug, Sutent, but fears that he may have to sell his home unless the NHS steps in.

"I have worked all my life, I have been in the forces, the prison service and the fire service for 30-odd years and I feel a little bit abandoned."

The staff and the hospital have been excellent but it is a little disappointing not to get funding when it has been proved [the drug] is working."

Sutent is licensed for use on the NHS but has yet to be assessed by the National Institute for Clinical Excellence (Nice).

Cornwall Primary Care Trust (PCT) has said it is not prepared to pay the £22,000-a-year cost of the drug until it is formally approved by Nice and recommended for use across the NHS.

Martin Cooper, consultant oncologist at the Royal Cornwall Hospital, said: "PCTs have to judge how to use their resources wisely.

"They don't feel in this case there are enough proven benefits from this drug to prescribe it for this unfortunate man."

Mr Quance said he had identified more than 100 patients elsewhere in the UK who had been prescribed Sutent and had their treatment paid for by the NHS but his appeal to the PCT was turned down.

Rose Woodward, from the Kidney Cancer Support Group, said Mr Quance's situation was "appalling". "Even in Mexico and Korea this drug is available, but not in the south-west of England. It is a very callous way to treat terminally ill patients."

In a statement the PCT said: "The NHS usually only funds drugs that are approved by Nice [and]...have gone through appropriate clinical trials. To date, Sutent has not been approved."

Cancer drugs

Herceptin (trastuzumab)

Breast cancer - approved by Nice in 2006 for use on the NHS.

Mabthera (rituximab)

Non-Hodgkin's lymphoma - approved in 2004.

Glivec (imatinib)

Chronic myeloid leukaemia - approved in 2003.

Erbitux (cetuximab)

Bowel cancer - refused approval in January 2007. Awaiting appraisal for head and neck cancer (expected June 2007).

Avastin (bevacizumab)

Bowel cancer - refused approval January 2007. Awaiting appraisal for lung cancer (expected January 2008), advanced breast cancer and advanced kidney cancer.

Tarceva (erlotinib)

Lung cancer - awaiting appraisal.

Sutent (sunitinib)

Kidney cancer - not referred for appraisal by Department of Health.

Nexavar (sorafenib)

Kidney cancer - awaiting referral by Department of Health for appraisal.

Velcade (bortezomib)

Multiple myeloma - awaiting appraisal.

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