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27 Sep 2011

Cancer treatment: cost versus benefit

Should dying cancer patients be spared “futile” and expensive treatment which can offer “false hope”? Channel 4 News hears from cancer experts, a charity and a patient.

Should dying cancer patients be spared

Writing in The Lancet Oncology journal, a group of cancer experts said dying cancer patients should be spared “futile” and expensive treatment which can offer “false hope” in the last weeks of life.

Warning of a tendency to “overdiagnose, overtreat, and overpromise”, they said the medical profession had created a set of “unrealistic expectations” with regard to the disease.

Terminally ill patients could even be better off if they “forego” certain treatments which would reduce spending and potentially improve end of life care, the academics said.

Led by Professor Richard Sullivan, of King’s College London, they said developed countries were now heading towards a “crisis in medical-care delivery” with cancer surgery becoming “unaffordable”.

“Special consideration must be given to costs of cancer care at the end of life,” they wrote.

My life’s been extended and I don’t consider that a waste of money. Trevor Lines, cancer patient

“Many forms of cancer are currently incurable and patients will eventually die from their disease.

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

‘I wouldn’t be here now’

Trevor Lines from Colchester has terminal kidney cancer.

The 67-year-old told Channel 4 News he has been given life extending drugs, not approved by The National Institute for Health and Clinical Excellence (Nice), on two occasions.

In 2009 he was given Sunitinub which kept his cancer at bay for around 20 months.

Then a year ago he started taking Everolimus, which was paid for when the government gave primary care trusts (PCTs) money to fund drugs which Nice had not approved.

Trevor took the drug for five months before the side effects became life-threatening.

“Had I not been given drugs which Nice said no to I wouldn’t be here now,” he said.

Trevor is not taking any drugs at the moment and has been given months to live although he says he is “quite convinced” he will see Christmas and beyond.

He said: “There are two schools of thought on this: if the cancer’s going to kill you then why delay it? But my life’s been extended and I don’t consider that a waste of money.”

Macmillan Cancer Support’s Policy Manager Duleep Allirajah told Channel 4 News it is “insulting” to say treating terminally ill people and extending life is “futile”.

He said: “From the perspective of an accountant it may be a waste of money but for the patient and family extra life is hugely important.”

Mr Allirajah accepted there does have to be a limit on cost but he added there is not a culture of excess when it comes to cancer drugs for the terminally ill in the UK.

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