7. Cancer policy

Question 1

how many premature death are caused by cancer?

Answer 1

1 in 6

Question 2

why is cancer increasing in incidence?

Answer 2

1. diet and lifestyle
2. aging population
3. more carcinogens in the environment
4. Socioeconomic development
5. shift from infectious diseases to non communicable diseases

Question 3

how much does the UK spend on healthcare?

Answer 3

12.6% of the GDP

Question 4

how much does cancer cost to the NHS?

Answer 4

1. £7.6 billion
2. extra burden on patients
   - cost of living
   - not being able to work
   - transport costs

Question 5

Does increasing cancer spending reduce mortality?

Answer 5

no compelling evidence
more money is not the solution we need to be spending the money better
cancer cost are increasing because cancer rates and cost of treatment is increasing

Question 6

why does the NHS need to do health rationing?

Answer 6

because there is a bottomless demand but limited money so we need to decide how to spend it

Question 7

what explicit rationing happens in the NHS?

Answer 7

NICE guidelines
- cost per QALY
- commonly used but feels weird to say its not worth the money
- what criteria can we use/ what is quality of life
- need to be accountable, relevant, transparent, reversible

Question 8

what implicit rationing occurs?

Answer 8

limiting the supply compared to the demand
waiting lists - cannot provide you the treatment rn
health insurance in USA - cannot afford same level of care
co payments
opportunity cost - what you didn’t buy because you spent it on something else eg nightingale hospitals in covid

Question 9

why does the UK have more medical rationing then the USA?

Answer 9

we have a higher sense of what is medically worth it
- we won’t treat you just for the money or if it isn’t going to have a benefit

Question 10

what was the cancer drugs fund?

Answer 10

£200 million ring fenced for just cancer drugs
- why when other diseases could benefit more?
most of the drugs extended life by only 3 months
was got rid of as it cost too much and was deemed unfair

Question 11

what is the ESMO clinical minimum benefit scale?

Answer 11

1. stricter then NICE
2. does the patient live longer?
3. is there progression free survival?
4. are people living better?
5. use of clincial trials?

Question 12

what is ESMO?

Answer 12

European society for medical oncology

Question 13

what % of cancer drugs are approved by the ESMO criteria?

Answer 13

20-35%

Question 14

what do drug companies often do with cancer drugs?

Answer 14

they find a way to get around cost negotiations and have less evidence of effectiveness
this means more expensive drugs that should still be in clinical trials

Question 15

how detrimental was the cancer drugs fund to other healthcare?

Answer 15

3500 QALYs gained by cancer patient
displaced from 18,000 QALYs from other healthcare patients

Question 16

so what was the cancer drugs fund?

Answer 16

a polical move that was not about the lives that could be saved but about access to new drugs
created no incentive fo drug companies to lower costs pushing up prices
diversion from the fair allocation of NHS resources for maximum benefit

Question 17

what happen when some of the cancer drugs applied for ESMO approval?

Answer 17

many of them don’t meet the criteria and are pushing profit over patients
Note: there is no association between cost of drug and benefit

Question 18

what things distort decisions on cancer policy?

Answer 18

1. the significance of cancer free survival and the fact its based on a 3 month scan
2. progression free survival in clinical trials
3. impact of industry deciding what we value
4. time toxicity
5. we are at the mercy of the companies that fund the trials

Question 19

what should the 2 goals for new treatments be and why are they not used in clincial trials?

Answer 19

1. live longer
2. live better
   these are not used because they are hard to measure and don’t give quick results
   patients are generally not happy with progression free survival being used

Question 20

what strange thing can help patients live longer?

Answer 20

just asking how they are feeling

Question 21

what won’t a clinical trial show?

Answer 21

1. the efficacy in a real world environment
2. the impact on different demographics then the tested patient group

Question 22

what are still the best cancer treatments?

Answer 22

the older more generic chemotherapies but even these are unaffordable to most of the world

Question 23

when are most cancer costs spent?

Answer 23

in the last year of life

Question 24

what cancer care happens in the last year of life?

Answer 24

1. end of life care/ hospice
2. being in hospital especially high dependency beds
3. lots of people receive chemo in the last 30 days of life which isn’t beneficial however this can only be measured in hindsight

Question 25

what can help patients live longer?

Answer 25

supportive palliative care

Question 26

what is time toxicity?

Answer 26

spending too much time in hospital and not much outside
even the most beneficial hospital treatments will give 2/3 months of life
for patients its worth it for others its not

Question 27

what is Choosing Wisely?

Answer 27

a global campaign to promote conversations between patients and clinicians

Question 28

what things influence cancer research funding?

Answer 28

1. the general research agenda
2. Pharmaceutical regulation
3. media coverage
4. public opinion
5. government
6. overutilisation of resources
7. Advocacy of oncologists