Cervical cancer link to early sex as sexually transmitted infection, HPV, causes most cases

Having sex at an early age can double the risk of developing cervical cancer, a study of 20,000 women suggests.

The investigation into why poorer women have a higher risk of the disease found they tended to have sex about four years earlier than more affluent women.

Previously, it had been thought the disparity was the result of low screening uptake in poorer areas.

The International Agency for Research on Cancer findings are published in the British Journal of Cancer.

Although the difference in cervical cancer incidence between rich and poor - across the world - had been noted for many years, it was not clear why this is the case.

Especially as rates of infection with human papillomavirus (HPV) - the sexually transmitted infection linked with the vast majority of cervical cancers - seemed to be similar across all groups.

The study confirmed that the higher rates of cervical cancer were not linked to higher HPV levels.
   
But what it did reveal is that the two fold increased risk was largely explained by women from poorer backgrounds starting to have sex at a younger age.

The age at which a woman had her first baby was also an important factor. Screening was found to have some effect on the level of risk.

But the number of sexual partners a woman has and smoking did not account for any of the difference.

Study leader, Dr Silvia Franceschi, said the findings were not restricted to adolescence and the risk of cervical cancer was also higher in women who had their first sexual intercourse at 20 rather than 25 years.

"In our study, poorer women had become sexually active on average four years earlier. So they may have also been infected with HPV earlier, giving the virus more time to produce the long sequence of events that are needed for cancer development."

Dr Lesley Walker, director of cancer information at Cancer Research UK, said the study raised some interesting questions.

"Although women can be infected by HPV at any age, infections at a very young age may be especially dangerous as they have more time to cause damage that eventually leads to cancer.

"Importantly, the results back up the need for the HPV vaccination to be given in schools at an age before they start having sex, especially among girls in deprived areas."

So after a dozen years of nanny state sex lectures the current crop of school leavers are worse off- as are the UK taxpayers.

From:

http://news.bbc.co.uk/1/hi/health/8420690.stm

Breast removal for cancer is postcode lottery, study shows

Women with breast cancer are five times more likely to undergo a mastectomy rather than have less invasive surgery in some parts of the country compared with others, research has shown.

Sufferers living in some parts of the North are far more likely to undergo the major operation, rather than having the "breast conserving" surgery more common elsewhere, according to NHS figures revealing a "postcode lottery" in cancer care.

Statistics showing the ratio of mastectomies to less invasive procedures to treat breast cancer, show that Redcar and Cleveland, in the North East, is the place where patients were most likely to have at least one breast removed.

Those in the London borough of Richmond and Twickenham were the most likely to receive treatment which removed just part of their breast, with radiotherapy used to prevent the spread of tumours.

The statistics show that those living in Wolverhampton, West Midlands, the London borough of Kingston, South Staffordshire and Telford in Shropshire were also more likely to have mastectomies.

Research has found that for many women with breast cancer, either treatment has a similar survival rate, if the tumour is of a size where it can be removed without the whole breast being lost. The chance of drastic surgery was highest in the North. 

Women living in Redcar and Cleveland, in the North East, were five times as likely to have their whole breasts removed, rather than part of them, compared with those living in Richmond and Twickenham.

Those in Ashton, Leigh and Wigan, in the North West, Middlesbrough, in the North East and Bassetlaw in Nottinghamshire were also most likely to have mastectomies.

The new NHS figures, placed in the House of Commons library, show massive variations in practices across the country. Analysis found no relationship between the patterns and rates of survival in different parts of the country.

Experts said it was impossible to know from the data whether the massive discrepancies reflected the choices made by women from different areas, or pressure put on them by surgeons.

Cancer charities urged surgeons working in the areas most likely to carry out mastectomies, to carry out further investigations.

Women with breast cancer should be offered the option of mastectomy, or less invasive surgery backed by radiotherapy. Research has shown that for most women, the survival chances are similar, although those with larger tumours may have no choice but have the more drastic operation.

Meg McArthur, from Macmillan Cancer Support, said: "These variations are really substantial, and they really do require further investigation. In some cases – such as the way a tumour is positioned, women would have no choice but to have a full mastectomy, but that really wouldn't explain the scale of the difference shown here."

She said it was vital that women diagnosed with breast cancer were given full information about the risks and benefits of different treatments.

"I would want all surgeons to look closely at these figures, and for primary care trusts to examine them closely too," Miss McArthur added.

Dr Jane Maher, chief medical officer for Breakthrough Breast Cancer, said it should not be assumed that women in areas most likely to have mastectomies were necessarily being put under pressure to undergo the procedure. Many women given information about the risks and benefits of both procedures chose the more drastic surgery, because they felt more able to put their fears behind them if they took the most extreme option.

From:

http://www.telegraph.co.uk/Breast-removal-for-cancer-is-postcode-lottery-study-shows.html

Cancer research at risk in scramble for care funds

Research into cancer and dementia will come under threat from labour government plans to fund social care, experts warned.

Andy Burnham, the Health Secretary, told The Times that millions of pounds would be “reprioritised” from health research and development to pay the costs of the Social Care Bill..

Money will also be diverted from public health campaigns such as those on swine flu, sexually transmitted diseases and obesity.

The Bill, a key plank of Gordon Brown’s pre-election legislative agenda, has been condemned by Labour peers, scientists and health campaigners. It would guarantee free care at home or other support for up to 400,000 elderly and disabled people from next October, at a cost of £670 million a year.

Mr Burnham, disclosing for the first time how he planned to pay for the proposal, said that £60 million would be diverted from the health service’s research and development (R&D) budget and £50 million from public health promotions.

Further funds will be sought as part of a “major productivity drive”, he said. The NHS is expected to make up to £20 billion in efficiency savings over the next four years. Hospitals could see their income tied to levels of patient satisfaction on matters such as the quality of maternity care.

Scientists warned of the consequences of cutting research budgets, which help to support the clinical trials of new medicines.

Nick Dusic, director of the Campaign for Science and Engineering, said: “This is extremely disturbing as the NHS budget was supposed to be ringfenced to protect long-term investment into the health needs of this country. In any department any raid on the R&D budget is supposed to be discussed first with the Government’s Chief Scientific Adviser. If they’ve breached this process it’s an extremely worrying development that needs to be looked into.”

Health ministers are expected to be interrogated in detail about which elements of the R&D budget should be cut to pay for social care as part of a continuing inquiry by the Lords Science and Technology Committee.

Lord Warner of Brockley, the Labour peer and former Health Minister who last week described the social care proposals as “totally misjudged”, said: “I will be looking at the Bill very carefully to see if my worst fears are confirmed and whether the figures really do add up.”

Mr Burnham defended the Bill from claims that it amounted to “an admiral firing an Exocet into his own flagship”.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6930661.ece?token=null&offset=0&page=1

Dramatic postcode lottery for cancer survival rates shock charities

Department of Health figures have shown a wide variation in cancer survival between different parts of the UK with lung cancer patients in Herefordshire three times more likely to die within a year than those in Kensington and Chelsea.

The country's biggest cancer charity has expressed shock at government figures revealing huge variations in patients' chances of surviving from one area of the UK to another. The biggest survival gap was in lung cancer, where Department of Health figures showed patients in Herefordshire were three times more likely to die within a year of diagnosis than those in Kensington and Chelsea. 

In the London borough, 44% of patients survived the first year after diagnosis, compared with only 15% in Herefordshire.

In bowel cancer there was also a big gap in survival – 80% in Telford and Wrekin after one year, but only 58% in Waltham Forest and Hastings and Rother. The gap was less pronounced in breast cancer, with the best rate in Torbay, where 99% survived for one year, compared with 89% in Tower Hamlets.

"There is no excuse for such a big difference between different areas," said Harpal Kumar, chief executive of Cancer Research UK. "It is appalling that someone with lung cancer in Herefordshire should be three times more likely to die within a year than a patient in Kensington, or that a person diagnosed with bowel cancer in Waltham Forest or Hastings should be 22% more likely to die within a year than a patient in Telford. This is the worst kind of postcode lottery."

Very few primary care trusts (PCTs) had survival rates that were as good as other countries in Europe now or even as good as Europe was achieving 10 years ago, which Kumar called "a disgrace".

"We're pleased that the Department of Health have been bold enough to publish these figures," he said. "The NHS now needs to take them very seriously."

One-year survival figures highlight the issues around delayed diagnosis of cancer. That can be partly the responsibility of the GP, who may not see many cancer cases in a year, but is often to do with the reluctance of the patient to seek medical advice when they suspect a problem.

The figures are contained in the Cancer Reform Strategy second annual report from national cancer director Mike Richards, who points out that cancer deaths continue to fall and that prevention efforts, such as the cervical cancer vaccination programme for schoolgirls and better screening, will further help.

Jeremy Hughes, chief executive of Breakthrough Breast Cancer, said the charity shared the concerns. "Although progress has been made in some parts of the country, in others key Cancer Reform Strategy initiatives are still yet to be implemented," he said. "In particular, urgent action must be taken to ensure that digital mammography is in place by the December 2010 deadline and that, as previously committed by the government, all women with breast problems referred by their GP will see a specialist within two weeks by the end of this year."

Here are the PCTs with the best and worst records for dealing with common types of cancer, in terms of the proportion of patients who are still alive one year after diagnosis:

Breast cancer- Worst
Tower Hamlets (89.3pc)
Hillingdon (89.5)
Barking and Dagenham (90.2)
Hastings and Rother (90.3)
West Hertfordshire (90.6)

Breast cancer- Best
Torbay Care Trust (99.0)
Darlington (97.9)
Stockport (97.6)
Warrington (97.6)
Western Cheshire (97.6)

Colorectal cancer- Worst
Hastings and Rother (57.8)
Waltham Forest (57.9)
Tameside and Glossop (61.5)
Derby City (62.6)
Enfield (62.6)

Colorectal cancer- Best
Telford and Wrekin (80.0)
City and Hackney (77.5)
Shropshire County (77.0)
Peterborough (76.7)
Plymouth Teaching (76.6)

Lung cancer- Worst
Herefordshire (15.4)
Milton Keynes (17.5)
Blackpool (18.3)
East and North Hertfordshire (20.3)
Hartlepool (21.1)

Lung cancer- Best
Kensington and Chelsea (43.7)
Hammersmith and Fulham (35.3)
Richmond and Twickenham (35.2)
Islington (34.8)
South Birmingham (34.6)

Health Direct has compiled this post from:

http://www.guardian.co.uk/society/2009/nov/30/cancer-survival-rates-figures
and
http://www.telegraph.co.uk/health/healthnews/6693438/Cancer-survival-rates-best-and-worst-trusts.html

Cancer sufferers face delay of weeks before receiving the test results in postal strike backlogs

Thousands of cancer sufferers will have to wait weeks for the results of diagnostic tests because of the likely national postal strike, patients’ groups said.
 

The news came as leaders of the Communication Workers Union met to discuss when to call the first national postage strike for two years. An announcement is now due on Tuesday, after talks went on all day.

The Patients’ Association also warned that many people would miss appointments with consultants because their appointment cards were likely to be caught up in the postal strike.

During the last national strike in 2007, 200 million items of post ended up in a mail mountain that took weeks to clear.

Michael Summers, vice chairman of the Patients’ Association, said the likely mail mountain caused by any strike would cause more anxiety and worry for anyone waiting for their GP to receive diagnostic tests for illnesses such as heart disease and cancer.

He told The Daily Telegraph: “It is worrying enough for patients, made much worse if they have to wait longer to receive the information. I hope the health service is alive to these problems.”

Mr Summers said that it would be better if the Department of Health allowed patients or GPs to receive the results of tests by email, or via a secure part of a website.

Asked about how hospitals would cope in the likely national postal strike, a spokesman for the Department of Health said that local health trusts would have their own contingency plans.

A spokesman said: “The local NHS should have contingency plans to cope with postal disruption.”

The Daily Telegraph understands that union leaders are considering proposals to hold a strike for 24 hours or 48 hours, followed by a series of rolling stoppages.

The rolling strikes, for 24 hours at a time, would hit mail centres, delivery offices and sorting offices on successive days, potentially paralysing the network for several days.

Sources described this strategy as the "nuclear option".

The CWU is legally bound to hold some form of strike action within 28 days of the result of last Thursday's ballot, at which CWU members voted by three to one to hold a national strike.

The union must give Royal Mail managers one week's notice of any strike action, which means that the stoppage could be held as soon as next week.

From:

http://www.telegraph.co.uk/Postal-strike-cancer-sufferers--face-delay-of-weeks-before-receiving-their-test-results

Health Direct thinks that it is ironic that labour's spin about new cancer targets is undermined by their own dithering and inability to make a decision. 

Does anyone remember the serial liar mandleson proclaiming in the summer that he would sort the mail's pension problem? Where is that lie now- in the gutter alongside millions of undelivered letters.

Cancer postcode lottery- London patients get three times more funding than those in Leicester

The full extent of Britain's postcode lottery in cancer care has been laid bare by research showing some health trusts are spending three times as much per patient as others.

Huge variations in funding mean that cancer sufferers' chances of being given life-extending drugs, surgery, and specialist care vary wildly from one part of the country to another.

While the average amount spent on a cancer sufferer in some parts of London is almost £15,000 a year, in Leicestershire it is less than £5,000.

Cancer experts said the research, carried out by The Sunday Telegraph, exposed a "grotesque lottery" in which life-and-death decisions were routinely being made by bureaucrats who were "unelected, unaccountable and unqualified" to make the rulings.

The figures obtained by the paper give the most detailed picture so far of the postcode lottery in cancer care.

Data from 150 Primary Care Trusts for 2007/2008 detailing cancer funding was divided by separate NHS records showing the number of cancer sufferers in each area.

Average spending was highest in Tower Hamlets, in East London, where cancer patients were allotted £14,697 for the year.

Those living in the cities of Birmingham, Leeds and Manchester all received average funding of at least £12,500.

Spending was lowest in Leicestershire and Rutland, with just £4,989 allotted to the average patient; about £500 more was spent in Harrow, North London, Hampshire, Northumberland and North Yorkshire.

Last year a study of patients with advanced cancer showed a tripling in the life-expectancy of those given drugs which many PCTs refuse to pay for.

Research on patients treated by University Hospitals Birmingham Foundation Trust compared the fate of 40 given the drugs Sutent and Nexavar for kidney cancer with 40 whose requests for funding were denied.

Those given the drugs survived 22 months, while those denied them lived just seven months, the study found.

Prof Nick James, director of research and development at University Hospital Birmingham, said: "A lot of PCTs are severely restricting access to drugs which can make a substantial difference to survival".

While PCTs across Birmingham had agreed to fund many drugs for cancer patients living within their borders, those living further afield could only secure the same treatment if they won lengthy battles with bureaucracy, Dr James said.

The oncologist and professor of oncology at the University of Birmingham added: "Clinicians and patients in some areas are forced to battle continuously with bodies which are unelected, unaccountable and unqualified".

He said that patients and doctors wasted "hundreds of hours" drafting appeals, writing to MPs and campaigning in the local media in an attempt to be heard by PCTs who often failed to even reply to correspondence.

The research found that PCTs across the country spent an average of £7,807 on cancer patients per year.

Jonathan Waxman, professor of oncology at Imperial College London, accused the labour Government of devising a "grotesque lottery" of local decision-making by PCTs in order to duck the blame for difficult decisions.

He said: "It is an absolutely absurd system, which is exposed by this excellent investigation. These discrepancies in funding are the reason people die.

"Why should how you are treated depend on where you live, and on decisions made by 150 different organisations who don't have specialist knowledge of the patient?"

The study found the gulf between funding allocated in different parts of the country was growing.

Figures analysing spending per head of population showed the highest spending in Leeds, at £157 per head, compared with just £48 per head in the London boroughs of Camden and Newham.

The gap between the PCTs spending the most and those spending the least per head of population (weighted to take account of the health of the local population) increased from £70 to £109 between 2006/2007 and 2007/2008.

Cancer charities expressed alarm at the extent of the differences revealed by the research.

Sarah Woolnough, head of policy at Cancer Research UK, which raises funds to find treatments for cancer, said: "These huge variations in how much PCTs spend are worrying. We urge the Government to ensure that all PCTs deliver an efficient and high quality service for cancer patients in the face of predicted NHS cutbacks".

Mike Hobday, from Macmillan Cancer Support, said: " We know there are some PCTs which say yes to everything, and others which almost always say no, and that is something that we are concerned about.

"Some variation is to be expected, and in fact is necessary to meet the needs of particular populations, but it is really important that those commissioning services examine these findings closely".

Dr Peter Marks, director of public health at NHS Leicestershire County and Rutland, said its local death rates for cancer were significantly lower than in the rest of England, while survival rates for specific cancers were similar, and in some cases better, to those elsewhere.

Shadow Health Secretary Andrew Lansley described the findings as "extremely concerning".

He said: "Britain languishes near the bottom of the table in Europe when it comes to five year cancer survival rates. It's clear that ministers' promises to improve access to cancer drugs and treatments are ringing hollow for many vulnerable patients."

From:
Cancer-lottery-London-patients-get-three-times-more-funding-than-those-in-Leicester

Patients with suspected cancer forced to wait so NHS targets can be hit

Patients rushed to hospital with suspected cancer are having their treatment delayed so that managers can meet labour Government targets, an NHS investigation has found.

People arriving at Accident and Emergency departments with symptoms which could indicate the aggressive spread of the disease are waiting weeks for diagnosis and treatment while “routine” cases are prioritised.

Hospital managers told researchers that treating desperately sick patients more quickly would “reflect badly” on their performance against Government cancer targets which only cover those referred to specialists by GPs.

Doctors, patients groups and politicians were appalled by what one described as a “breathtaking admission” which confirmed their “very worst fears” about how far the NHS target culture has gone in distorting clinical priorities.

Although most people with suspected cancer are referred to hospitals by their GPs, more than 30,000 people diagnosed with the disease each year are first alerted to tumours by violent symptoms, such as seizures, vomiting and jaundice, which cause such alarm that patients go straight to their local A&E departments.

The report by the NHS Institute for Innovation and Improvement, an official health service agency which issues advice to hospital managers, says that many of these emergency patients waited six weeks or longer for basic tests.

It said they were “often” not given the same priority as patients who had been referred by GPs, who were covered by two targets, ensuring that they see a specialist within two weeks, and start treatment, following diagnostic tests, within two months.

“As a result, they can end up with a very poor experience before finally receiving a diagnosis and the right care,” it warns.

The report, added: “Many trusts recognised the need to get some patients in this group onto the same pathway as people on the cancer two week wait [target] but were concerned this would reflect badly on their cancer figures”.

Some A&E departments failed to recognise the risk of cancer in seriously ill patients. In cases where the disease was suspected, patients were sent home to wait six weeks or longer for diagnostic tests. Others waited weeks on wards before seeing a specialist or having scans, the report, which is endorsed by the Government’s cancer tsar, found.

Nigel Beasley, the NHS Institute’s lead for cancer, and head and neck surgeon from Nottingham University Hospitals said: “Targets are very effective, but they do have side-effects. The risk is that these patients are not being prioritised because of the focus on the two-week target for patients referred by GPs.”

Mr Beasley said: “Patients can be stuck in hospital for a long time, waiting for scans, and other diagnostic tests. Once they are in hospital, they can end up waiting two, three, or even four weeks before there is a diagnosis and any decision to treat.”

The admission about the effect Government targets were having on emergency cancer patients horrified clinicians and patients groups.

Shadow health secretary Andrew Lansley described it as “one of the clearest examples yet of how Labour’s tick-box targets are failing NHS patients”.

He said decisions about which patients should be seen first must be taken by doctors, based on the patient’s clinical needs, not by managers following Government diktats.

Katherine Murphy, from the Patients Association, said the report provided “breathtaking” evidence of a confidence trick being played on the public, repeatedly told that waiting times for patients with suspected cancer are falling, while desperate cases were forced to the back of the queue.

She said: “This confirms our very worst fears, and exposes the scandal of what pernicious targets are doing to patients. We have seen other targets being used in ways that damage patient care, but of everything we have seen, this really is the cruellest of the cruel”.

Leading cancer specialist Prof Karol Sikora said: “I think it is absolutely horrifying that hospital managers are playing around with targets that can delay treatment for people who may well be at an advanced stage of the disease.”

“I know of many cases where people who have been admitted to NHS hospitals as an emergency have languished for weeks before even seeing an oncologist,” added Prof Sikora, Medical Director of independent company CancerPartnersUK.

The British Medical Association said many trusts were bullying doctors into delaying urgent referrals.

Dr Jonathan Fielden, chairman of the BMA’s consultants committee, said: “A number of our members have already expressed fears about the two-week cancer target, because it means all the cases referred by GPs are given the same priority, regardless of whether they are expected to be benign or high risk. When this same target is delaying patients who have been admitted as an emergency that is an even greater cause for concern”.

Several oncologists said they supported two-week waiting time targets for cancer patients referred by GPs, but called for the target to be widened to include all patients.

Ian Beaumont, from charity Bowel Cancer UK said it “beggared belief” that anyone would value statistics over efforts to save lives.

Dr Jane Maher, chief medial officer at Macmillan Cancer Relief described the revelation in the report as worrying, but said the biggest obstacle to getting the right care for patients admitted to hospitals as an emergency was getting the right diagnosis, as cases were often complex, meaning cancer could be mistaken for other conditions.

From:
Patients-with-suspected-cancer-forced-to-wait-so-NHS-targets-can-be-hit.html

Swine flu- hospitals could turn away critical patients in a pandemic

Hospitals could be "rapidly overwhelmed" and forced to turn away critically ill patients if a flu pandemic reaches Britain, according to the Government's own assessment.

A Department of Health document warns that the health service is already working close to its capacity, leaving little scope to meet the demands of a mass outbreak of swine flu, which could force doctors to turn away patients needing intensive care.

The document, seen by The Daily Telegraph, says cuts in the number of beds since Britain last underwent a pandemic in 1969 – combined with an ageing population and changes in the way patients are treated – mean intensive care units "could be rapidly overwhelmed".

The disclosure of the document last week came as:

Nicola Sturgeon, the Scottish health minister, reported that there has probably been the first British case of swine flu in someone who has not travelled to Mexico, indicating that the virus has begun to pass between people here;

Three new cases were confirmed in Britain;

Countries around the globe continued to report new cases of H1N1, with new confirmed cases in Holland. the Republic of Ireland and Germany.

Authorities in Mexico, the source of the outbreak, asked for a five-day shutdown of non-essential business and travel in an attempt to slow the spread of the disease.

The world is now on the brink of the first flu pandemic in 40 years, with the World Health Organisation's (WHO) alert status at five out of six.

The Department of Health is printing leaflets to put through every door urging people to find "flu friends" who can bring them groceries and supplies if they fall ill.

However, the Department of Health (DoH) document seen by The Daily Telegraph warns that, during the peak of a flu pandemic, complications such as pneumonia could mean there are 10 times as many people requiring ventilators as the NHS can supply.

If demand cannot be met, it recommends doctors deny treatment to the weakest patients so that resources can be shared among the greatest number.

The draft document, which was written in September before the outbreak of swine flu, acknowledges that its recommendations open "controversial ethical issues" and could cause anger and violence from relatives of those refused care.

Doctors taking decisions to deny care are urged to fully document their decisions to protect themselves from litigation, while hospitals are warned that "additional security decisions may be necessary because of the risks of violence directed at staff making triage decisions".

The document, Pandemic Influenza: surge capacity and prioritisation in health services, sets out the criteria which doctors should use to determine which patients receive intensive care.

If there is competition for places in intensive care units, patients suffering from advanced cancer could be refused beds along with pensioners suffering from severe burns, those with multiple organ failure and children suffering from advanced cancer, severe burns or trauma.

If patients competing for life support are likely to have an equal benefit from treatment, decisions should be taken by lottery, the guidance concludes.

The document describes the pressures that the NHS suffered during the last two pandemics, in 1957 and 1969, which caused a total of 3 million deaths worldwide.

It states that the impact of the 1969 outbreak was lessened by a high number of spare hospital beds at the time. The document says cuts to spare bed capacity, so that the health service is now working "at or near capacity", a 31 per cent increase in the number of over-65s, a more complicated out-of-hours system for GPs and more widespread use of critical care would all make it more likely that intensive care units could be "rapidly overwhelmed".

Meanwhile, NHS Direct took a more than 10,000 calls in total on Wednesday and almost 3,000 of them related to swine flu – more than double the calls received on Monday about the virus, reflecting how public concern is growing.

A spokesman for the DoH said: "We have published this draft guidance to help clinicians to work within an ethical framework during a pandemic."

From:
http://www.telegraph.co.uk/health/swine-flu/5254149/Swine-flu-hospitals-could-turn-away-critical-patients-in-a-pandemic.html

NICE U turn as kidney cancer patients to get Sutent drug on NHS

Terminal kidney cancer patients will receive an expensive drug on the NHS, following a U turn by the labour Government's drugs rationing body.

The National Institute for Curbing Expenditure (Nice) has approved the use of Sutent, which costs around £27,000 a year, in its final decision yesterday.

But the body will turn down three other kidney cancer drugs insisting that they are not "cost effective" for the health service.

Nice sparked outrage in August last year when it initially turned down Sutent, claiming it was too expensive.

At the time patient groups and cancer charities accused the body of condemning sufferers to an "early death".

The drug, which can prolong life for months, is used in the treatment of patients with terminal kidney cancer.

Since its initial draft guidance on the use of the drug Nice has agreed with the labour Government to look more favourably on drugs which prolong life when it makes it decisions.

This, coupled with an offer from Pfizer, the company which makes Sutent, to cut the price, means that the drug will be approved for use on the NHS.

Under the agreement, Pfizer will pay the £3,139 cost of the first six-week cycle of the drug, with the health service paying the rest of the costs.

Three other kidney cancer drugs, Avastin, Nexavar and Torisel, are expected to be rejected because the body has deemed them too expensive for the benefits they provide.

Around 7,000 people are diagnosed with kidney cancer in Britain every year and an estimated 3,600 could be eligible to receive Sutent.

Earlier this year it was announced that the drug, also called sunitinib, would be given to patients in Wales, paid for by the Welsh Executive, even before the Nice announcement.

Prof Robert Hawkins, Cancer Research UK Professor and Director of Medical Oncology at Christie Hospital Manchester, said: "I am delighted that Sutent will be available.

"It will remove a great deal of anxiety and uncertainty for people diagnosed with renal cancer to know that modern, effective treatment is now available to them."

James Whale, from the James Whale Fund for Kidney Cancer, said: "Finally, we have justice for the kidney cancer community. This positive recommendation from Nice will allow thousands of kidney cancer patients in England and Wales access to this life extending treatment.

"The options previously available to us have been limited and are inadequate for the majority of patients. For some, sunitinib is the only hope."

From:
http://www.telegraph.co.uk/health/healthnews/5044196/Kidney-cancer-patients-to-get-expensive-drug-on-NHS.html

Health Direct asks how many people have been condemned to an early death by labour's killer quango whilst it dragged it's feet over spending NHS money?

new labour top up rules for cancer drugs creates more red tape as fear of litigation mounts

The labour government is having to rewrite its guidance on implementing cancer czar Mike Richards' recommendations for top up payments.

Trusts have been observing the draft guidance since it was published in November. As it stands, primary care trusts face increased bureaucracy as an unintended consequence.

Cancer clinicians are already expanding the number of requests for exceptional funding sent to PCTs to include "clinically non-exceptional cases".

Traditionally, the exception route was only open to patients with recognised criteria such as an unusual health need where no commissioning policy was in place.

But in a move likely to be followed by other trusts, Mark Wright, Royal Marsden Foundation trust's head of contracts, has written to commissioners saying the trust must now send exceptional case requests even where the patient does not meet exception criteria.

Exhaust all routes

This is to fulfil the requirement to "exhaust" all NHS funding routes before allowing private treatment.

"While the trust does not want to compromise the quality of the existing [exceptional circumstance] process, it is unavoidable that clinically non-exceptional cases may need to be submitted under this guidance," the letter says.

The DH said the line in the guidance about exhausting all reasonable avenues for securing NHS funding was "an important safeguard for patients", but revised guidance, which took into account consultation responses, would be published shortly.

A spokeswoman said: "There is no intention to require clinicians to use exceptional funding procedures where this would be clearly inappropriate."

National clinical director for cancer Mike Richards told HSJ: "During the consultation, comments have been made about this particular point and clearly the DH is now considering that in drawing up the final guidance."

PCT CONCERN OVER CONSTITUTION

Measures in the NHS Constitution to increase transparency will allow patients and their legal teams to crawl over primary care trust decisions and seek judicial review.

Lawyers have raised concerns over the duty for PCTs to demonstrate they followed internal processes to the letter and set out clear reasons when making decisions. The constitution even reminds patients they can seek a judicial review if they believe the NHS has acted unlawfully.

There is also a risk that, as well as patients and lawyers attending exceptional case panel hearings and challenging results, drug companies and patient groups could send round robin letters to PCTs demanding to know their reasons for all funding decisions, before targeting legal action on PCTs with weaker rationales.

Inconsistent decision making

Commissioners fear the twin threats will exacerbate inconsistent decision making.

UK Public Health Commissioning Network chair Daphne Austin said: "Where it breaks down is whether or not [PCTs] can hold their commissioning position… Some PCTs find it hard to say no to patients coming to the individual funding request panel even though it is obvious the patient is not an exception.

"The minute one PCT says yes, the next one gets pressure."

The DH said the constitution was a "declaratory document" and had not been set out in primary legislation, in order to avoid it becoming a lawyers' charter.

From:
hsj.co.uk/news/2009/02/nhs_topup_rules_set_for_rewrite_as_fear_of_litigation_mounts

Health Direct asks, apart from the sheer incompetence of labour's red tape, if the DoH claims that the new expensive NHS constitution lacks teeth, what on earth is the point of it- apart from to increase labour's spin on the NHS?

Killer quango NICE in cancer drug Sutent U Turn

Thousands of kidney cancer patients should soon receive an expensive drug that could prolong their lives on the NHS following an about turn by the labour Government's drugs rationing body NICE.

The National Institute for Curbing Expenditure (Nice) has issued new guidance recommending that patients with the cancer should be given Sutent, or Sunitinib, following a public outcry.

Last year NICE was accused of condemning sufferers to an "early death" when it recommended that the drug was not "cost effective" for the health service.

However, Nice has revised that guidance after taking into account new rules requiring greater funding for expensive drugs that can help terminally ill patients.

Coupled with an offer from the manufacturers, Pfizer, to make the drug cheaper, Nice said that its new draft guidance was that Sutent should be prescribed on the NHS.

Under the deal, Pfizer, will pay the £3,139 cost of the first six-week cycle of the drug, with the NHS picking up the rest of the bill, expected to be just over £30,000 a year.

In a statement, Nice said that it accepted that the drug was a "clinically effective treatment".

The organisation has recommended that it be used for patients whose cancer is advanced or has spread to other parts of their body, and who currently have few other treatment options.

However, it still recommends that three other kidney cancer drugs, Avastin, Nexavar and Torisel, are too expensive for the benefits they offer.

Cancer experts said that the new guidance on Sutent would make an "enormous difference" to patients.

Around 7,000 people are diagnosed with kidney cancer in Britain every year and an estimated 3,600 could be eligible to receive Sutent, which is widely available in countries like Germany and France, and last month given to patients in Wales.

Currently patients with the advanced stage of the disease are offered just one drug, Interferon, to which many sufferers do not respond.

Sutent has been shown to increase survival by several months, and in some cases for up to two years, but does not cure the disease.

Andrew Dillon, the chief executive of Nice said: "Having decided that one of these treatments should be recommended for use in the NHS, we felt that it was in the interests of patients to get that advice out as quickly as possible.

"Although this final recommendation is subject to appeal we very much hope it will form the basis of our guidance to the NHS."

Professor John Wagstaff, from the South West Wales Cancer Institute, said: 'This really fantastic news for people with kidney cancer... (this will) make an enormous difference for patients and for clinicians.'

Dr David Gillen, medical director, Pfizer Limited, said Sutent had become "the new standard of care in the rest of the world" for kidney cancer patients.

"Not only will this decision have immediate benefits for eligible patients today, but will also pave the way for future treatment advances in kidney cancer," he said.

In recent months Nice has agreed payment deals to allow a number of expensive drugs to be prescribed on the NHS.

These include Lucentis, which can improve the sight of sufferers of a degenerative eye condition, Tarceva, for lung cancer, and Revlimid, for a rare type of blood cancer.

Nice has previously faced controversy over its advice that Herceptin, the breast cancer drug, could only be used for advanced cases. Following public pressure and legal battles the drug was allowed for early stages of the disease.

The organisation is currently looking at its advice that Aricept, which costs £2.50 a day, be given only to Alzheimer's patients with advanced stages of the disease.

Final guidance on the use of the four kidney cancer drugs is expected in March.

From:
http://www.telegraph.co.uk/health/healthnews/4449605/Kidney-cancer-patients-should-get-Sutent-on-the-NHS-says-NICE.html

NHS to widen drugs range in NICE U Turn

A wider range of costly “end of life” treatments for terminal illness is to be made available on the NHS, the body that recommends which treatments the service should adopt has confirmed.

Sir Michael Rawlins, chairman of the National Institute for Curbing Expenditure (NICE), said it would issue new guidance to its advisory committees which would have the effect of raising the price the NHS should pay for treating some terminal illnesses.

The new guidance will apply only to conditions likely to affect small numbers of patients a year – up to about 7,000 – and who have a life expectancy of two years or less.

Following the row over patients having to “top up” their NHS care by paying for life-extending, but not curative, drugs, Sir Michael said Nice had recognised that “people attach a special importance to extending the lives of [those with] mortal illnesses, even for a few months, and we appreciate these extra weeks and months can be very special”.

As a result, he told the BBC in an interview, its new guidance would “have the effect of extending the threshold range of what we would normally regard as cost-effective”.

Nice has been consulting on the change, which has been warmly welcomed by the pharmaceutical industry.

However, the NHS Confederation, which represents health authoritiesand trusts, has warned that such drugs will come at the expense of other treatments. Primary care trusts, which buy care on patients’ behalf, have fixed budgets, the confederation said in its response. If more is spent on end-of-life care, “then as cash-limited organisations, primary care trusts will need to reduce spending elsewhere”.

“There is some concern that treatments, interventions and services that are more cost-effective, but not subject to Nice guidance, will lose out to pay for the high cost of end-of-life drugs,” it said. The proposals “could lead to less cost-effective medicines being prioritised over those able to provide greater overall benefit”, it said, arguing that it was not entirely clear that society wanted to benefit small numbers of patients in that way.

The confederation said there was also concern “the proposed change could encourage the pharmaceutical industry to focus on end-of-life research, product development and marketing at the expense of other health priorities”.

By contrast, the Association of the British Pharmaceutical Industry welcomed the change, saying it believes that it better reflects “societal preferences in the allocation of scarce resources”. But it warned that proving cost effectiveness, even at the higher threshold, would be “extremely challenging in some cases”, because care at the end of life is often expensive and even the limited improvement in life expectancy that some of these products bring would add to already high costs.

It also questions the justification for the new threshold being limited to treatments likely to affect only 7,000 patients a year who have limited life expectancy.

However, Sir Michael said that to raise the threshold for more common conditions, on which it is easier for the industry to make its money back, would cost the NHS “hundreds of millions of pounds a year”.

From:
http://www.ft.com/cms/s/0/6929870a-d39c-11dd-989e-000077b07658.html

Cancer survival rates vary widely, statistics show

Cancer survival rates in England have remained static, new figures reveal. But wide variations still exist between five-year survival rates for different types of cancer, according to Office for National Statistics data for 2005 - the latest available.

Ninety-six per cent of men diagnosed in England in 2000 with testicular cancer survived five years, as did 81 per cent of women diagnosed with breast cancer.

Survival rates for those diagnosed in 1999 were also 96 per cent and 81 per cent respectively.

Five-year survival from lung cancer for patients diagnosed in 2000 was 7 per cent for men and 8 per cent for women, also unchanged from 1999.

Cancer Research UK head of policy Catherine Foot said the Department of Health's NHS cancer plan, published in 2000, had led to "real improvements" in cancer treatment, including reduced waiting times, more specialist surgery and more cancer doctors.

Improving survival

"All these things as well as reductions in smoking rates and better access to new cancer medicines will lead to improvements in cancer survival five years after diagnosis.

"But this takes time to be seen in the statistics," she said.

"Over the next few years, it is absolutely essential that the NHS focuses on improving the early detection of cancer, as we believe that diagnosing more patients earlier could significantly improve overall cancer survival."

From:
cancer_survival_rates_vary_widely_statistics_show

NHS top-up confusion grows after labour's U turn on funding

Campaigners are demanding clarity over whether patients using non drug-based NHS services will be able to "top up" their care.

National clinical director for cancer Mike Richards' review of co-payments allowed patients to pay for drugs that are not funded by the service, as long as private care was given separately from NHS provision.

Charity Age Concern is now calling on the Department of Health to clarify how far its logic may extend to other situations where NHS funds are used to provide care.

Grey areas in current policy include care home residents fearing they will be forced to meet all their bills once they are paid for with continuing care funding. "We can't see how you can say you can top up all these other things and not top up the care home you wish to go to".

There are also questions around new policy areas, such as individual budgets for healthcare.

Age Concern care finance policy adviser Pauline Thompson said the charity had heard of cases where elderly care home residents had been afraid to apply for NHS continuing care funding because they feared they would be forced to move to cheaper homes.

She said care home residents should be allowed to top up health service payments, but that their rights to NHS funding must also be spelled out clearly.

"With current support for the idea of being able to top up, we can't see how you can say you can top up all these other things and not top up the care home you wish to go to.

"But we'd also wish to make absolutely sure that there were some mechanisms in place to ensure that the NHS did pay the going rate."

Direct payments

King's Fund senior policy adviser Anna Dixon said whether patients would expect to top up individual health budgets was likely to depend on whether the Department of Health's pilot scheme allowed for direct payments - as in social care - or was simply a "nominal budget".

People receiving direct payments under the social care system are currently allowed to top up.

"The suggestion at the moment is that they are not going to go down the route of direct payments, which would suggest that it probably won't be possible," she said.

From:
clarify_rules_on_nondrug_topups_campaigners

NHS hospitals allowing top up cancer drugs payments

Health Direct has learned that payments to top up NHS care - supposedly banned - are happening at 30 hospitals across the UK.

Professor Mike Richards, the cancer tsar for England, has been holding a review about so called co-payments and will report at the end of this month. The issue is also under review in Wales and Scotland.

But patients are already topping up their NHS care, as hospitals find ways around the current rules.

The current rules say you cannot mix and match between the NHS and private.

You are either all NHS and it is free or you're all private and you pay for everything.

But the details are interesting. The code of practice says a patient cannot be both an NHS patient and private in the same episode of care.

So in Birmingham they have found a way round the ban on top ups.

Separately another consultant at the same hospital writes a private prescription for the drugs that patients wants to keep them alive.

They are supplied at patients' homes by a private company called Healthcare at Home.

They pay the company direct. So the administration of the drugs is viewed as a separate episode of care.

Professor Nick James is the oncologist in Birmingham who designed this model of allowing patients to top up their care.

"Nowhere does it say that an episode of care is from diagnosis to death of your cancer" he said. "So we've just interpreted the rules in a way which is in favour of the patients."

Across the country

What is remarkable is that topping up, something the labour government says is banned, is not just happening in Birmingham.

The company which provides the drugs to Ian says they have contracts with 30 NHS hospitals across the country.

Mike Gordon, chief executive of Healthcare at Home, said: "Top ups are happening today and they'll happen tomorrow. So long as they're done through us not using the auspices of the NHS I see no reason why they shouldn't continue."

A Department of Health spokesperson said: "We know there is variation in how individual Trusts are applying the current guidance, and that is why the Secretary of State asked Professor Mike Richards, National Clinical Director for Cancer, to lead a review into this difficult issue.

"Professor Richards is looking at how a consistent approach across the country might be best achieved."

Shadow Health Secretary Andrew Lansley said: "David Cameron and I have pressed the Health Secretary, Alan Johnson, to enter into a risk sharing scheme for the kidney cancer drug Sutent in order that patients will be able to access this life saving treatment immediately, but nothing has been done."

Norman Lamb, for the Liberal Democrats, said: "We are in an outrageous situation where patients are left in a lottery, dependent on a few hospitals which are bending the rules.

"This case makes the need for reform all the more urgent."

All Ian Jenkins wants is to stay alive as long as possible.

But his story does raise the question, why the need for a high level review of top ups if they are already happening all over the country?

From:
http://news.bbc.co.uk/1/hi/health/7668121.stm

Dying patient forced to pay £20,000 for NHS care

The grieving family of a woman who died last week tells why health service rules on top-up co payments for cancer drugs must be changed.

A mother of three has died from cancer after her family was forced to pay £20,000 for treatment she was denied by the National Health Service because she had bought a drug privately.

Carole Simmons, 59, died last Tuesday, the third person known to have died after suffering from the labour government’s policy of withdrawing NHS care from patients who buy top-up drugs.

Her death comes in the middle of a government review of top-up treatment, which was ordered after a campaign by The Sunday Times exposed the scandal. The review panel is due to report to Alan Johnson, the health secretary, later this month.

This weekend relatives of Simmons, who lived in Yapton, West Sussex, spoke out in the hope of sparing other families from suffering the same tribulations. Simmons’s husband Kevin, 59, a former divisional officer in the fire service, described what happened when she was diagnosed with bowel cancer last December.

“They more or less said that Carole had no hope, that she only had weeks to live,” he said. “They were sending Carole home to die.”

In an attempt to give Simmons more time, her family paid privately for a drug called Avastin, which was not available on the NHS. They believe it prolonged her life.

However, under labour government rules their NHS treatment was then withdrawn. As well as the cost of Avastin, the family had to pay about £20,000 for routine drugs, scans and consultant appointments that would otherwise have been available on the NHS.

“We got nine precious extra months with Carole which we may not have had if we didn’t have the money,” said Simmons. “We want Carole’s legacy to be that this policy will be changed so that this doesn’t happen to anyone else and top-ups are allowed.”

During the extra time she was given, Simmons, a former teaching assistant, saw a grandchild start school, enjoyed a family holiday in France and attended her sister’s 40th wedding anniversary in Jersey.

Simmons’s youngest son, Chris, 28, a solicitor, said: “Some people may be able to raise the money for the extra cost of the drug but they may not be able to pay for all the treatment, such as scans and consultant fees. Instead of ordering a review, Gordon Brown should have ended this immediately and allowed people to pay just for the extra cost of the drugs.”

He added that paying for Avastin had given “us time to put our affairs in order and to say our goodbyes”.

Simmons’s daughter Kate, 30, a civil servant, points out that her mother had paid for her NHS care. “Our mum worked all her life, apart from when she was bringing us up. She never claimed unemployment benefit and always paid her national insurance and taxes,” she said.

“Our mum really wanted us to speak out so that this would not happen to another family.”

The Simmonses paid for the drug and basic NHS care from savings and a loan. “This was my parents’ pension savings. They didn’t have the money lying around,” said the eldest son Colin, 35, a local government manager.

Simmons was treated at St Richard’s hospital in Chichester before her NHS care was withdrawn. She then paid for Avastin and her treatment, including scans using NHS equipment, at the Spire Portsmouth hospital in Havant.

The Royal West Sussex NHS Trust, which runs St Richard’s hospital, said it was following government guidance by refusing to allow Simmons to continue to receive NHS care while paying for the Avastin.

The government inquiry, which is being carried out by Professor Mike Richards, the government’s cancer czar, was ordered in June following the disclosure in The Sunday Times that another bowel cancer patient, Linda O’Boyle, 64, from Billericay, Essex, had died after her NHS care had been withdrawn because she paid privately for the drug Erbitux.

In May last year Sandra Baker, 62, from Walgrave, Berkshire, died of bowel cancer after being denied NHS treatment because she paid for a drug.

Simmons is the first patient known to have died during the government inquiry after being denied NHS treatment. She would have celebrated her 40th wedding anniversary today.

Her local MP, Nick Herbert, the shadow justice secretary, said: “I am horrified that my constituents have had to use their savings in this way. The awful situation at the moment is that if you do manage to scrape together the money to buy these drugs yourself, your NHS treatment is withdrawn. This puts patients in a terrible dilemma.”

Most leading health organisations, including the British Medical Association, the Royal College of Nursing (RCN), the NHS Confederation, which represents hospital managers, and the King’s Fund and Reform think tanks, have said top-ups must be allowed.

The Roy Castle Lung Cancer Foundation and the Patients Association have both backed top-ups in their submissions to the inquiry.

While the RCN accepts that allowing top-ups is necessary, nurses’ leaders warn that the change could create “business class” treatment for NHS patients who can afford it and thus potentially undermine the founding principles of the NHS.

Others argue that there is already a two-tier health service, as those who can afford to pay for all their care go to private wings of NHS hospitals.

The government inquiry, to be published at the end of this month, is expected to propose that patients should be allowed to pay for additional drugs without losing their NHS care.

Kate Spall of the Pamela Northcott Fund, which campaigns on behalf of patients denied drugs on the NHS, said: “Let us hope that Carole’s tragic story will bring about the end of this situation for patients.”

From:
http://www.timesonline.co.uk/tol/news/uk/article4882645.ece

Cancer patient with months to live wins court order for last-chance drug on NHS

A cancer patient has won a legal battle against the NHS to be given a drug that doctors say could prolong his life by up to three years.

Colin Ross, 55, of Horsham, West Sussex, has multiple myeloma, a cancer of the blood cells, and was not expected to survive to see Christmas unless he was given a drug described as his “last chance”.

The High Court overruled the decision by West Sussex Primary Care Trust that treatment would not be cost-effective, and said that Mr Ross should receive Revlimid as an exceptional case.

Mr Ross had incurable cancer diagnosed in May 2004. In an interview with The Times last month he said that he was “sickened” that he was being denied the £30,000-a-year treatment even though the drug was available to patients living only a few miles away in East Sussex.

But despite the exhortations of doctors treating Mr Ross at the Royal Marsden Hospital, the specialist cancer hospital in London, the trust had, since March, repeatedly refused to fund the drug, raising the issue of a so-called postcode lottery for NHS treatments.

However, Judge Simon Grenfell, sitting in London, condemned the trust’s decision as “one which no reasonable authority could have made on the application before it”.

Revlimid is among the most expensive of new cancer treatments and is readily available to patients across Europe and in the United States and Scotland.

But it has not yet been granted approval by the National Institute for Curbing Expenditure (NICE) and, because of the cost, is likely to be rejected. It is provided by only some trusts in England and then only in exceptional circumstances.

The case is likely to encourage other cancer patients who may have been denied expensive drugs on the NHS, but experts emphasise that the case does not set a legal precedent and that decisions will be taken case by case in other areas.

The judge issued an emergency injunction to enable Mr Ross to begin treatment today, but the ruling was made on an interim basis pending a further appeal and not as the start of permanent treatment.

Mr Ross was too ill to attend court for the ruling but his long-term partner and carer, Wendy Forbes-Newbegin, 52, who has breast cancer, cried after the victory.

She said after the judgment that the family’s treatment by the NHS had been “appalling”.

“The mental anguish that we have been through has at times been unbearable, and wholly unacceptable in this day and age,” she said.

“Colin’s diagnosis and recent prognosis have been so awful in the first place, but to have to endure all the months of waiting for this life-prolonging treatment has been nothing short of shameful in the first degree.”

Mr Ross, who has two children and four grandchildren, told The Times that he feared that delays incurred by his appeals to the trust and ensuing legal action may have reduced the effectiveness of the treatment.

“Depending on what the judges say, I could start treatment with Revlimid, or the doctors will simply refer me to start receiving palliative care,” he said last month. “My bed in the hospice is already booked. I realise the drug is expensive for the NHS, but to think that I could have a few extra months or years to spend with my daughters and watch my grandchildren grow up – I’ve never wanted anything more.”

Before yesterday’s ruling he was taking a cocktail of painkillers and other drugs “just to keep my head above water”, and was advised that Revlimid was now the only option.

In March, Mr Ross’s clinicians asked West Sussex PCT to fund Revlimid for three to four courses at a cost of £5,000 a course and presented evidence to show that it could give Mr Ross up to three more years of life.

He had been unable to purchase the drugs privately, he said. “Even if I could, the law states that I would have to become a private patient and forfeit the rest of my NHS care.”

Richard Clayton, QC, acting for Mr Ross, told the court during a two-day hearing: “This application for this drug is the end of the road for him. Either he gets the drug and is able to have life-prolonging treatment, or he doesn’t and treatment ceases, with inevitable consequences.”

He added: “Were the claimant to live a mile and a half in either direction from where he does, he would have received the drug.”

West Sussex PCT said that it was considering whether to appeal.

From:
http://www.timesonline.co.uk/tol/news/politics/article4727613.ece

Health Direct applauds the judiciary. Having had their power over life and death removed many years ago, it is heartening that they are taking the same power away from labour's faceless health bureaucrats who are condemning thousands to premature deaths in the name of NHS cash shortages.

NHS's refusal to fund cancer treatment costs mother £21,000

For Barbara Moss, the photographs of this summer's camping trip to France will be particularly special.Two years ago, she was diagnosed with bowel cancer and given less than five months to live. After chemotherapy failed to slow the disease's progress, doctors said that her only hope was a drug called bevacizumab, marketed as Avastin, which her local NHS refused to fund.

When Mrs Moss, 53, cashed in her pension to buy the drug, she was also made to pay for other NHS care that previously had been free. Her story highlights a national debate on drug rationing that is about to reach fever pitch.

Next month, Prof Mike Richards, the Department of Health cancer tsar, will announce results of a labour government review into rules that deny NHS treatment to patients who want to "top up" their care by paying for some of it. The Government had to examine the issue after a public outcry over the death in March of Linda O'Boyle, a grandmother denied free NHS treatment after buying the bowel cancer drug cetuximab, marketed as Erbitux.

Mrs Moss was prescribed Avastin by her consultant at Worcester Royal Hospital, but the primary care trust refused to fund it. Instead, the former schoolteacher and her husband, Mark, a toolmaker, cashed in their pensions, and were given money by Mrs Moss's 86-year-old mother to pay for the drug.

It shrank a secondary tumour in her liver so successfully that she was able to have it removed. When the cancer returned, she was once again denied Avastin. The couple spent a total of £21,000 on the drug and on the chemotherapy and nursing that Mrs Moss had previously received free of charge.

Latest scans show she is tumour-free. The cancer is likely to return, but already she has survived for 17 months beyond her original prognosis. On holiday in France, Mrs Moss said: "All this extra time has been so precious. I have been able to spend time with my husband and two sons, and it has helped them and me to prepare for my death. Every day now is a bonus, and I am grateful for that. But I am angry that after paying our taxes we had to take on these battles, and I feel really aggrieved for those people who cannot afford these treatments which are available in so many other countries."

Mrs O'Boyle's widower, Brian, recently had a private meeting with Prof Richards to discuss the top-up review. Last night Mr O'Boyle told The Sunday Telegraph that he wants the entire system of drug rationing overhauled, so that every patient gets the treatment their consultant prescribes.

The father of three said his wife, who was an NHS occupational therapist, would have been amazed by the impact her death has had. Worcestershire PCT said it had concluded that there was not enough evidence to support the use of Avastin for bowel cancer.

Southend Hospital Foundation trust, which treated Mrs O'Boyle, said the charges for her NHS care followed Government policy, which meant only one organisation could be held accountable for a patient's care.

The charity Bowel Cancer UK campaigns on behalf of patients seeking both Avastin and Erbitux. The drugs' use is restricted by the National Institute of health and Clinical Excellence (Nice), the rationing body, on the grounds of cost.

The charity and many bowel cancer doctors are critical of the Nice guidance, but also say PCTs do not have proper policies that should allow some patients to be given the drugs if their cases could be defined as exceptional.

Ian Beaumont, charity's campaigns director, said: "We think the current system is totally broken. All over Britain we have got patients who are having to battle the NHS system at the same time they are fighting cancer."

From:
NHSs-refusal-to-fund-cancer-treatment-costs-mother-21000.html

Health Direct thinks that it is quite absurd that a quango like labour's NICE should have the power of life and death over patients when such powers were abolished years ago for the judiciary.

The problem for the NHS is that labour has blurred the difference between for example top ups for dental treatment and those for life saving cancer drugs- with no idea of the size of potential extra income for the NHS if labour was to see sense and allow extra personal funding.

Healthcare postcode lottery means patients losing out on cancer treatments

The level of healthcare inequality across the country is disclosed in a detailed report which shows some areas are spending twice as much tackling heart disease and cancer as others.

"Postcode lottery" prescribing means some patients are not getting the same access to vital drugs and treatments as their neighbours.

In Knowsley, Merseyside, healthcare bosses spend £118 per head on cancer treatments, but in Ealing, west London, they spend just £47.

Middlesbrough spends £167 per head on circulatory diseases, including heart disease, compared with £76 by Southwark, central London.

The spending variations were "almost certainly not justified", warned Nial Dickson, the chief executive of the King's Fund, the influential health think-tank, which compiled the report.

The wide variations in how much the National Health Service trust spends on these diseases has remained unchanged for three years.

This despite an extra £9billion investment by ministers.

The spending variations were branded "unacceptable" and there were calls on the labour Government to investigate whether they were leading to higher death rates in some areas.

It comes amid increasing concerns over healthcare rationing with several high profile cases where patients have been denied drugs because they were deemed "too expensive" for a particular Primary Care Trust (PCT).

Last week, Colin Ross, a cancer sufferer who has been told he will not survive the autumn unless he receives the cancer drug Revlimid, took his case to the High Court.

Mr Ross, 55, who suffers from multiple myeloma, a cancer of the blood cells, was denied the drug, which costs £4,000 a month, by West Sussex PCT, Despite a leading cancer expert describing him as ``eminently suitable" for treatment. It could prolong his life by three years.

If he lived a mile-and-a-half away from his home in Horsham, West Sussex, Mr Ross's case would come under a different PCT where he would have been more likely to receive the drug.

Jane Tomlinson, the cancer campaigner who died a year ago, was denied a drug that doctors believed could prolong her life although neighbouring PCTs provided it. She eventually received it as part of a clinical trial.

The Government argues that rationing within the NHS is necessary to ensure that resources which could be spent elsewhere are not wasted and that patients receive only treatments which have real clinical benefits.

The new report show that while some PCTs spent more than nine per cent of their budget on cancer care, including drugs, some spent just 3.6 per cent.

The proportions ranged from 5.7 per cent to nearly 11 per cent for circulatory disease.

It also showed discrepancies in treatment for mental health problems. while some trusts spent 8.7 per cent of their budgets on treatments others spent 25 per cent.

Mr Dickson said: "This report raises questions rather providing answers.

"It does not mean that any one PCT's spending is necessarily wrong but it does suggest that as well as unexplained variations in clinical practice, there are unexplained spending variations - some of these are almost certainly not justified."

Norman Lamb, the Liberal Democrat health spokesman, said: "This analysis points to an unacceptable postcode lottery of care with Primary Care Trusts totally unaccountable to the communities they serve for these funding decisions."

He added: "This report begs urgent questions as to what extent these extraordinary variations in spending are affecting patient care and leading to higher death rates. The Government must investigate whether the funding allocations are fair."

The Tories have called for a system under which ministers would negotiate with drugs companies to bring down the cost of treatments which have proved effective, allowing them to be offered to greater numbers of patients.

David Stout, Director of the PCT Network, which represents most Primary Care Trusts in England, admitted that some of the differences could not be easily explained.

"While this may be due to inconsistencies in the data, it may reveal unacceptable variation in clinical practice or unexplained variation in investment," he said.

"While this analysis does not in itself provide the answers, it will help local primary care trusts to continue to ask the right questions about how they can best manage their resources."

Last month cancer charities and patients groups reacted angrily to a decision by the Government's drugs watchdog, the National Institute for Health and Clinical Excellence (Nice), that four life prolonging kidney cancer medications, costing around £24,000 a year, were not "cost effective" on the NHS.

The organisation has previously faced controversy over its advice that Herceptin, a breast cancer drug, could only be used for advanced cases.

Only after patients groups launched a campaign and legal fight was the drug allowed for early stages of the disease.

Nice has also stoked outrage by refusing to allow an anti-dementia drug, Aricept, which costs around £2.50 a day, in the early stages if Alzheimer's disease, meaning that thousands of patients have to wait for their condition to worsen before they can receive the drug.

The Government has ordered a review into whether to allow patients to buy their own drugs, under controversial "top ups", without having to pay for the rest of their NHS care, as the current system demands.

From:
Healthcare-postcode-lottery-means-patients-losing-out-on-cancer-treatments.html

Top doctors slam NHS drug rationing

Britain's top cancer consultants have accused the labour government’s drugs rationing body of ignoring the plight of patients forced to sell their cars and remortgage their houses to pay for cancer treatments freely available in Europe.

Twenty-six professors blame the severe restrictions imposed by the National Institute of Health and Clinical Excellence (Nice) on its failure to “get its sums right”.

Nice refuses, on grounds of cost, to recommend some drugs for patients with advanced kidney cancer. The consultants, who include the directors of oncology at Britain’s two biggest cancer hospitals, the Royal Marsden in London and Christie hospital in Manchester, claim there is enough money in the NHS to pay for the drugs.

Their letter to The Sunday Times states: “We now spend similar amounts to Europe on health generally and cancer care in particular, but less than two thirds of the European average on cancer drugs. It just can’t be that everybody else around the world is wrong about access to innovative cancer care and the NHS right in rationing it so severely.” They say: “The time has come for a radical change in how the NHS makes rationing decisions for cancer.”

This weekend Andrew Dillon, the chief executive of Nice, and Sir Michael Rawlins, the chairman, challenged the cancer experts to explain which acutely ill patients should be sacrificed to free resources for cancer sufferers.

They said: “There is a finite pot of money for the NHS, which is determined annually by parliament. If one group of patients is provided with cost-ineffective care, other groups – lacking powerful lobbyists – will be denied cost-effective care for miserable conditions like schizophrenia, Crohn’s disease or cystic fibrosis.”

This week patients from the Kidney Cancer Support Network will demonstrate outside the Nice offices in London against the refusal to fund the kidney cancer drugs Avastin, Sutent, Nexavar and Torisel.

Health Direct asks if National Insurance was brought in so that we could pay for our medicine . was NICE was brought in so there would be some money left in the kitty for "drinks at Christmas "?

Top-ups for drugs are fair says voters

Patients should be given the chance to pay extra for the best available drugs in addition to their NHS treatment, according to a Sunday Times poll.

Nearly two-thirds of those surveyed said patients should be permitted to top up their treatment. The government is reviewing the issue after a Sunday Times campaign.

According to the latest YouGov poll, 73% believe that if treatments exist they should be available on the NHS. Only 21% think there should be a limit on treatment. Nearly a third said they would be prepared to pay extra taxes so the more expensive treatments could be available on the NHS.

Alan Johnson, the health secretary, has asked Professor Mike Richards, the cancer czar, to consider whether so-called co-payments should be allowed again. The labour government has previously argued such a scheme would create a two-tier service and has warned patients that care may be withdrawn if they pay for drugs privately.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article4538256.ece

Health Direct asks why if labour allows the NHS to pay for the removal of 177,00 tattoos why don't they also fund cancer drugs?

Banned cancer drugs better than NHS ones

Privately bought cancer drugs are proving to be up to five times as effective as NHS treatments, Health Direct reports on the suffering the co-payments ban is inflicting on patients.

The National Health Service is providing dying cancer patients with drugs that are five times less effective than those available privately and is refusing to treat them if they try to buy medicines themselves.

One drug for kidney cancer, routinely available through public health systems in most European countries but not to British patients, can reduce the size of tumours in 31% of patients, compared with just 6% of those prescribed the standard NHS drug.

The growing row over “co-payments” has prompted the labour government to reconsider the ban. Alan Johnson, the health secretary, has promised a “fundamental rethink” of the policy.

The shift comes as increasing numbers of cancer doctors defy the official Whitehall ban and allow patients to pay for drugs while still receiving NHS care.

Doctors at the Royal Marsden hospital in London and consultants at the NHS trust in Swansea are offering patients NHS care while they pay to receive drugs that will prolong their lives. Recently the Sunday Times revealed that about 16 consultants in Birmingham are ignoring the government guidance.

Research presented at the American Society of Clinical Oncology found that kidney patients taking the new drug Sutent lived six months longer than those prescribed alpha interferon, the NHS treatment.

The failure of the NHS to make more effective drugs available to cancer patients has been condemned as “unethical” by leading doctors.

John Wagstaff, professor of oncology at Swansea University, said: “This has created a very difficult situation for us. Having seen the latest data, I believe it is now pretty unethical to give many patients alpha interferon [rather than Sutent]. We are often forced to prescribe interferon because we do not have access to Sutent [on the NHS], but I am always upfront with the patients. I tell them what I think the most effective treatment is.”

Eight times as many patients in Germany and France receive Sutent as in Britain, according to figures held by Pfizer, the manufacturer. Sutent, which costs about £2,200 a month compared with about £800 for the NHS drug, is one of a number of life-prolonging new drugs at the centre of the co-payments row.

In advanced kidney cancer, when the patient cannot be treated with any other drug, Nexavar, another medicine, can double the period when the disease is held under control.

A trial of Nexavar, comparing the effect of the drug with a placebo, showed it to be so effective that the trial had to be halted early as it was considered unethical not to give it to all the patients in the test. Tumours were prevented from growing for an average of 5.5 months in patients taking Nexavar, against 2.8 months in those taking the placebo. Despite the findings, Nexavar is not routinely funded by the NHS.

Similarly, bowel cancer patients are up to four times as likely to see their tumour shrink if they pay for Erbitux than if they take irinotecan, the NHS-approved drug, alone. A study published in the New England Journal of Medicine in 2004 showed that 23% of patients experienced a reduction in the size of their tumour when they took Erbitux and irinotecan.

Other studies showed that just 5% of patients have the same benefit from taking irinotecan alone. Those taking irinotecan alone had their bowel cancer under control for 4.2 months, but this rose to 8.6 months when Erbitux was added.

Erbitux, costing about £3,000 a month, is funded for bowel cancer in most European countries. Patients in France are 13 times, in Spain 10 times and in Germany nine times more likely to get the drug than Britons.

The drug Avastin offers similar benefits. Research presented earlier this year showed that patients who receive Avastin and routine chemotherapy before surgery are twice as likely to be alive two years later as those who receive only the chemotherapy available on the NHS.

A former fireman who developed liver cancer after 25 years’ service has been told that if he pays for the only drug that can treat his disease his NHS care will be withdrawn.

Barry Humphrey, 59, from North Walsham, Norfolk, was told by NHS doctors that the drug Nexavar was the only available treatment for his advanced liver cancer.

However, consultants at Addenbrooke’s hospital in Cambridge said the drug was not routinely funded by the NHS and told him that if he paid for it he would be billed for the rest of his NHS care.

Humphrey believes his cancer is linked to his time as a fireman. His cancer was caused by cirrhosis of the liver after he contracted hepatitis C. He believes he caught the virus from a casualty while on duty.

Research presented at the American Society of Clinical Oncology found patients with advanced liver cancer survive for an average of 11 months if they take Nexavar, while those denied the drug live for just eight months.

Humphrey’s wife Hazel, 58, who also worked in the fire service, said: “Doctors said this would ‘not be viable’ because we would be deemed as opting out of the NHS and would need to pay for everything.

“I think it is absolutely disgraceful. When people are terminally ill, they want to spend as much time as they possibly can extending their life expectancy.” She said the couple know the drug will not provide a cure but should have the right to spend their savings to prolong her husband’s life.

They plan to sell a flat that they have been renting out to raise the cash for the drug, which costs about £3,000 a month. Humphrey, who has four children, six grandchildren and helps to care for his elderly mother, said: “I think this is morally wrong and indefensible.”

Cambridge University Hospitals NHS Foundation Trust, which runs Addenbrooke’s, said: “We are complying with the national guidance which says we cannot allow co-funding.”

The public’s view

A poll for The Sunday Times shows strong support for allowing co-payment in the National Health Service, with 89% saying that people who buy additional cancer drugs should continue to get free NHS treatment.

Only 5% think allowing co-payment would create a two-tier NHS. Until now this has been the position taken by Alan Johnson, the health secretary.

Ministers had feared that allowing co-payment would upset less well-off patients, but the YouGov poll of nearly 1,800 people shows strong backing across the social spectrum and supporters of all three main parties.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article4138237.ece