CancerPartnersUK

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CancerPartnersUK

• The NHS and cancer care
• Karol Sikora, Medical Director
• Professor of Cancer Medicine
• Imperial College, London
• March 2009

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What people living with cancer want

• the best chance of cure with good quality of life
• honest, clear information on available options
• to have the diagnostics fast-tracked to 3 days
• to see the same specialist at every visit
• to access the latest scientific developments
• convenient, streamlined, focused services as
  close to home as possible with dedicated car
  parking
• to be treated in a decent environment with
  dignity
• to get the best care without worrying about its
  cost

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The National Cancer Plan 9 years on

• Up to 0.5bn added per year to NHS cancer care
  for last 5 years but this now stops
• NHS budget tripled to 102bn
• Target metrics in place but still running with
  huge under capacity in diagnostics and RT
• Staffing problems in RT leading to delays,
  rationing and lack of innovation
• Financial meltdown imminent - high cost drugs,
  IMRT and lack of ambulatory care facilities
• Continual evolution of stakeholders - PCTs, SHAs,
  Cancer Networks and NHS Trusts
• Increased patient empowerment and demand
• Survival data still poorest amongst EU13

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Eurocare 4 - four commonest cancers
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The cancer demand pyramid

NHS Insurers Regulators NICE Politicians
DEMAND LED SERVICES
TIME
Novel drugs Novel devices Additional
therapies Complementary medicine
CORE SERVICES
Pharma Providers Patients Advocacy Politicians Soc
iety Legal
NHS
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Predicted NDA dates for molecular
therapies
base case launch years in the US
Breast
2000
2005
2015
2020
2010
Lung
2010
2015
2000
2005
2020

Key
MAbs
Colorectal
Vaccines
2010
2015
2000
2005
Anti-Angiogenesis
Kinase Inhibitors
Apoptosis Inducers
Prostate
Anti-Sense
Gene Therapy
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Targeted therapies could lead to financial
meltdown
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NICE - Trastuzumab (Herceptin) early breast cancer

• Jun 05 ASCO data presented
• Aug 05 DH referred to NICE
• Oct 05 Health Minister announces availability
• Nov 06 Debated in Parliament
• Dec 05 Patient goes to High Court
• Apr 06 Patient wins in Court
• May 06 EMEA approval
• Jun 06 NICE publishes positive draft guidance
• Aug 06 Fast-track guidance published by NICE

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NICE - Sunitinib (Sutent) renal cell cancer

• Jan 06 FDA accelerated approval
• Jul 06 EMEA Market authorisation
• Jun 08 Health Minister says top-ups not allowed
• Aug 08 NICE negative final guidance
• Aug 08 protest from 26 academic oncologists
• Dec 08 DH review backs top-up payments
• Feb 09 NICE draft guidance approves 1st line only
• Feb 09 newspaper protest at unfairness
• Feb 09 NICE permits 2nd line use after IFN
• Mar 09 final guidance due

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Bevacizumab (Avastin) - colon cancer
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NICE - Lapatinib (Tyverb) breast cancer

• Feb 07 final scoping study
• Mar 07 FDA NDA passed
• Apr 07 closing date for evidence
• Jan 08 1st appraisal meeting
• Jun 08 EMEA market authorisation
• Sep 08 2nd appraisal meeting
• Nov 08 3rd appraisal meeting
• Jan 09 4th appraisal meeting
• May 10 expected guidance

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Ratio of E13 UK and TOP COUNTRY UK
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Cost per QALY inflation
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Cancer funding UK per PCT
Centre for Health Economics, York, 2007
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MC Cancer Network PCT spending on cancer
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NHS oncologist is willing and able to prescribe
the most effective drugs?
No
Are you ill?
No
Have you got cancer?
Yes
Have you got medical insurance?
Check the cover. Some insurers are beginning to
limit benefits
Purchase drugs for oncologist to administer on NHS
Yes
Yes
Yes
No
No
Prepared to self fund?
Remain an NHS patient
No
Yes
Legal challenge There is no legal reason as to
why patients cannot top up their NHS care
Survive on NHS
No
Will the oncologist let you top up your cancer
care while remaining an NHS patient? Some
oncologists will let you purchase cancer drugs
that can be administered as an outpatient and
remain an NHS patient. It gets more complicated,
if the drug needs to be administered in hospital.
Yes
Purchase a second opinion until Yes
No
Win
Yes
Yes
Intimate wish to take up residency and drug will
be prescribed
Is the drug available in England, Scotland, Wales
or Northern Ireland Yes No take up residence?
No
Survive on NHS
Yes
Win
Complain to the Chief Executive of Hospital
(copying the Healthcare Commission)
No
If your case goes to the PCT Exception Committee
and it is declined challenge the decision and
the authority of its members
Survive on NHS
Fail
Complain to local PCT It is generally accepted
that the majority of cancer sufferers who
challenge their PCT win
Yes
Win
No
Survive on NHS
Fail
Write to your local MP
Make cancer charities aware of your challenge
they can be a mind of information
Get in touch with Doctors for Reform, Halliwells
Solicitors, Pamela Northcott Fund
Get as much publicity as possible and do not
accept what you are given
Get in touch with the drug manufacturer
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Providing cancer care in 2029

• Cancer as a chronic, controllable illness
• Governments as regulators and insurers not
  providers
• Healthcare, insurance, pharmaceutical, academic
  partnerships create novel global provider
  vehicles
• Personalised medicine, NPT black box systems,
  implanted chip monitors, molecular diagnostics
• Cancer hotels in most towns
• New roles for cancer professionals
• Empowered informed consumers not patients
  option appraisal
• Co-payment biomarkers to reduce costs
• Total care and compressed morbidity