Sarah Kate-Templeton points out the post-code rationing between different regions in the UK, reinforces the case for having a home in Scotland as well as England, and is a denial of a National Health Service. The Sunday Times article “NHS denies Englishmen low-cost cancer drug” is honest. Is it reasonable to have periods of time when one region is completely different to another, and within that region the assertive and informed get better care?
MEN in England with prostate cancer are being denied an inexpensive drug that could give them an additional two years of life — while Scottish patients receive the treatment.
In Scotland, the drug, docetaxel, is given as soon as prostate cancer starts to spread. In England it is given at a later stage, denying patients 22 months of life on average.
To adopt the Scottish approach would cost the National Health Service nothing, but bureaucrats say they will not act until a trial is published in a peer-reviewed journal. The results of the trial have been described as “staggering” by Prostate Cancer UK.
The extra 22 months of life emerged in a major trial carried out in UK universities and NHS hospitals. Up to 5,000 men could benefit from the treatment every year.
The trial, called Stampede, was funded by Cancer Research UK and the Medical Research Council (MRC) and presented at cancer conferences in Europe and America.
NHS England says it cannot approve use of the drug at an earlier stage in the disease until the study has been published.
Professor Nicholas James, a cancer consultant at the Queen Elizabeth Hospital in Birmingham and chief investigator on the trial, said: “This is classic NHS bureaucracy and jobsworth behaviour.”
Scottish patients are given six courses of the chemotherapy drug, alongside hormone treatment, as soon as they are diagnosed with prostate cancer that has spread.
In England men are given 10 courses of the chemotherapy, but only after they have suffered a relapse while just receiving hormone therapy.
Doctors at Queen Elizabeth Hospital, run by University Hospitals Birmingham NHS Trust, are giving patients the chemotherapy as soon as the cancer spreads with the support of trust managers to do so. All Scottish NHS trusts are also giving the chemotherapy at the earlier stage.
Elsewhere in England, however, patients are being denied the chemotherapy when it has been shown to be of benefit to them.
James said: “What you would want to happen when, having shown that you can make people live two years longer with less treatment than you were giving before, is that you would want the NHS to adopt it pretty quickly.”
Iain Frame, director of research for Prostate Cancer UK, wrote in a blog: “The findings were staggering. These researchers showed a 22-month survival benefit from giving men newly diagnosed with metastatic prostate cancer docetaxel chemotherapy at the same time as hormone therapy . . . [Even though] docetaxel is an off-patent, inexpensive drug, we know that men are still being denied earlier access to this treatment. What’s more, we lack any sense of how long it will take for this to become standard practice.”
NHS England said: “Decisions such as these have to be made based on good-quality clinical evidence. We’ve committed to developing a policy once that evidence becomes available, which at this stage means waiting for the publication of the trial.”
Tony Doherty, 75, a retired engineer from Leicestershire, heard of the treatment through the charity Prostaid. He was surprised to be told by his NHS consultant in Leicester that he did not qualify until his cancer had relapsed. He sought a second opinion from James in Birmingham and is starting chemotherapy with docetaxel on the NHS there.
Doherty is concerned that other men, who are not as well informed or as “pushy” as he, may be denied the treatment.
“It makes me very happy that I am getting something rather than just being left to wait until my PSA [prostate specific antigen] goes up and that is the end of it,” he said.
“If I can get the chemotherapy then I maybe stand to get another couple of years out of it.”