Wednesday, 28 September 2011

Palliative care and cancer issues - quality of life vs length of life

Cancer is a heart breaking disease.  The sadness at losing a cherished grandparent, father or mother or young child to cancer  is very great.  The EU, Russia, China, Japan and USA face an aging population and cancer is therefore a more common cause of death in families.

Terminal cancer raises particular dilemmas. 

A group of 37 cancer experts has criticised a "culture of excess" which promises drugs to patients who have terminal cancer.

Health service spending on cancer medication has increased from £3 billion annually to £5 billion and the expert panel said it made doctors "over treat, over diagnose and over promise."

More than 300,000 people in Britain are diagnosed with cancer every year and the figure is predicted to increase to 400,000 by 2030.

The panel, headed by Professor Richard Sullivan of King's College London, wrote in an article published in the journal Lancet Oncology: "Special consideration must be given to costs of cancer care at the end of life. Many forms of cancer are currently incurable and patients will eventually die from their disease."

"If we could accurately predict when further disease-directed therapy would be futile, we clearly would want to spare the patient the toxicity and false hope associated with such treatment, as well as the expense."

"In fact studies suggest that a substantial portion of the total cost of cancer care is for care delivered in the last weeks or days of life, and that much of this care is futile and potentially inconsistent with patients' wishes."

'Many forms of cancer are currently incurable and patients will eventually die from their disease,' the experts wrote.

Responding to the article, Duleep Allirajah, policy manager at Macmillan Cancer Support, said that palliative care costs are currently higher than necessary.

'But to call palliative care treatment 'futile' is extremely unsympathetic and undermines each patient's personal experience and desire to extend their lives,' he argued.

Mr Allirajah also called for more joined-up cancer care, particularly when a patient is discharged from hospital, which he said could free up ten per cent of cancer spending.ADNFCR-554-ID-800741121-ADNFCR

Cancer, a global challenge,  Kings College London

Cancer experts from around the world, led by Professor Richard Sullivan at King’s College London, have advised that ‘a radical shift in cancer policy is required’, as a report on the affordability of cancer care in high income countries is published today.  

The first ever Lancet OncologyCommission report is being presented to the 2011 European Multidisciplinary Cancer Congress in Stockholm, Sweden. The Commission brings together 37 experts from High Income Countries in a comprehensive analysis that points out where these countries have lost their way in managing cancer costs, and future challenges.

The Commission was led by Professor Richard Sullivan from the King’s Health Partners Integrated Cancer Centre, a collaboration between King’s College London and its partner NHS Foundation Trusts – Guy’s and St Thomas’ and King’s College Hospital.

Cancer affects some 12 million new patients each year, causing 7.5 million deaths. With an ageing global population and an endless conveyor belt of expensive new drugs and technologies and increasing financial pressures, the cost of cancer care in high-income countries is becoming unsustainable and urgent solutions are needed, say the report authors.

Professor Arnie Purushotham, Director of King’s Health Partners Integrated Cancer Centre and a co-author of the report, says, ‘There is acknowledgment that the economic burden of health care in general, and high-quality cancer care in particular, will become unaffordable without genuine effort to address these issues. It is important to understand the drivers contributing to the burgeoning cost of cancer care and develop policy to address these factors.

While some issues are very specific, such as the huge development costs for new cancer medicines, other cost drivers are common across the spectrum of cancer care, such as over-use, rapid expansion of demand, and shorting life cycles of medical technologies: both drugs and imaging techniques. There has also been a tendency towards more defensive medical practice, a less informed regulatory system, and a declining degree of fairness to all patients with cancer.

The authors identify a whole range of immediate and medium term measures that need to be introduced to reduce the current cost base of delivering cancer care and manage the future cost curves of particularly expensive interventions such as cancer medicines. Radical action is needed to simplify and integrate patient treatment pathways, new models of care with lower cost bases need to be implemented and a whole new approach to expensive interventions – from mandatory cost effectiveness analysis, to the prohibition of off-label use and new economic models for reimbursement and incentivisation - must be driven through healthcare systems.

Educating the public, patients and policymakers about the key issues in delivering affordable cancer care is also essential, say the authors. 

Professor Richard Sullivan said: ‘We are at a crossroads for affordable cancer care, where our choices – or refusal to make choices – will affect the lives of millions of people.  Do we bury our heads in the sand, keep our fingers crossed, and hope that it turns out fine, or do we have difficult debates and make hard choices within a socially responsible, cost effective, and sustainable framework?  The consensus from all those involved is that policy makers, politicians, patients, and health care professionals need to address this issue now’.  

‘We believe that value and affordable cancer care can be introduced into the cancer policy lexicon without detracting from quality, and that the management tools, evidence, and methods are available to affect this transformation across all developed countries.

‘The global challenge to countries is how to deliver reasonably priced cancer care to all citizens – i.e. make cancer care affordable to individuals and society,' he concluded.

The full report can be accessed here:

Also at the European Multidisciplinary Cancer Congress in Stockholm, Sweden


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