As the western world's population ages, the cost of cancer care skyrockets. Is it time to start thinking about the rationing of cancer healthcare? John Humphrys considers the issues to ask, at what price comes extended life?
In this world nothing is certain but death and taxes. That’s what Benjamin Franklin said and it’s hard to argue with it even two centuries later. But even though we cannot escape death what we can do – as never before – is delay it. Diseases that would have carried us off in the blink of an eye in Franklin’s day can now be held at bay, sometimes for years. At a price. The question in modern society is: how big a price should we be prepared to pay?
That question has been on the front pages this past week because of a report from The Lancet Oncology Commission on the cost of cancer care in rich countries. In simple terms, it said no healthcare system can afford to pay for the huge increases involved in prolonging the life of a cancer patient for a few weeks.
This is one of those issues that transcends the purely economic, practical and even ethical arguments. At its root is a profoundly important moral question: if we have the ability to prolong a person’s life how can we justify not doing so?
Imagine that you have been diagnosed with terminal cancer. Your doctor tells you there is a new drug on the market that could prolong your life by a year but it is very expensive. You would obviously say: 'Hang the expense, I want it!' And you would be right.
But what if he told you it would prolong your life by a week, would you still insist on having it? And what if you were very old? And what if the cost was so great that prescribing it for you might deny another, younger, person the treatment she needed? Then it becomes less obvious. This is the dilemma that has been exercising some of our top doctors – amongst them Professor Karol Sikora, one of Britain’s most eminent cancer specialists and one of the authors of the Commission’s report. He believes that we are truly at a crossroads in cancer treatment.
The population of the western world is ageing and that, together with our increasingly unhealthy lifestyles, have dramatically increased the incidence of cancer. Which means the cost of cancer care has increased dramatically too. Prof Sikora says the the cost of the new technology to deal with this could be staggering. The last eight drugs approved this summer in the United States will cost an average of nearly £10,000 a month per patient – not counting the cost of their administration or any possible side effects. And the benefit? In many cases as little as two months, but never more than seven months.
And here’s another frightening statistic. The cost of getting a single new drug to market is now more than £700 million. Once again, if we reduce this to a personal level and you or your loved ones are the people who benefit, there is surely no argument. Let’s go for it. But one of the biggest problems Skiora and his colleagues face in modern cancer treatment is getting the right drug to the right patient. Huge advances are being made in what the experts call the 'molecular signature' of a tumour, but much more research is needed. In the meantime vast amounts of money are being spent by pharmaceutical companies hoping that theirs will be the next blockbuster drug.
What worries people like Sikora and many of his senior colleagues is that we are not engaging in a properly informed debate in this whole area. Surprisingly, the drugs companies refused to participate in the Lancet Commission’s work.
Here’s what Sikora wrote this week: 'We need more honesty and transparency. We all have to face the difficult decisions 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, he says, has to decide how much to put on the price of life. Doing what 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.
Do you agree?
- Is Professor Sikora right to question the cost of new drugs or do you believe that it is not possible to put a price on life?
- Have you, or someone else close to you, been denied drugs that you regarded as 'life-saving'?
- Do you accept that the prescribing of a drug should be limited by how long it extends the patient’s life?
- Do you believe we spend too much or too little on cancer research at the expense of other illnesses or do you believe cancer is an illness in a class of its own?