Message from Professor Sikora
“Each year 250,000 people in Britain will develop cancer. It affects one in three of us and there are currently 1.3 million people living with the disease. By 2020 this number will rise to 3 million. This is good news as it means we are making cancer a controllable illness. But medical advances cost money and cancer care is no exception. Innovation in drug and radiotherapy technology is amazing. Driven by a better understanding of the molecular defects that result in abnormal growth, and precision, pin-point accuracy in radiotherapy, we can now target the specific differences between normal and malignant cells better than ever before.
Cancer care costs are spiralling out of control in every healthcare environment. Ageing populations with a wide range of medical problems are consuming vastly increasing amounts of care. New technology – drugs, devices and procedures – are powerful inflationary drivers in an information rich, consumer world. In the era of Google, the old paternalistic medical monopoly of health knowledge is gone forever.
People and their families want to break through access barriers. This applies to areas as diverse as implanted hearing aid devices, access to diagnostics such as scans and even home nursing care services. Many politicians, whatever their persuasion, have until now been in denial, preferring to continue the myth that the NHS can provide everything to everybody free of charge. Meanwhile some cancer patients have learned to become very sophisticated consumers of clinical services within the NHS.
Over the last decade an increasing number of cancer drugs have been licensed. Some are expensive. In the UK those responsible for commissioning care in the NHS have been increasingly challenged by patients and their relatives to provide new cancer drugs. Over 40 are now in the final stages of the global development pipeline. These are the products of the molecular revolution triggered by the discovery of the structure of DNA 1953 and the development of remarkable techniques to examine the function of genes, gene expression and proteins. Most of them will receive their market authorisation within the next three years. They work by targeting the molecular cogs of signal transduction between the cell surface and the nucleus. This is an exciting time for those involved in cancer research and care.
Drugs are not the only problem. Precision based radiotherapy techniques which considerably reduce the side effects of radiotherapy given with radical intent are now possible. Intensity modulated radiotherapy (IMRT) and image guided radiotherapy (IGRT) are techniques to ensure a more precise deposition of radiotherapy to the tumour. They allow an increased dose to be delivered to the tumour without side effects so increasing local control in prostate, lung, breast and head and neck cancers. Delivery costs are higher as they require more sophisticated planning and longer linear accelerator time. Currently 50 of Britain’s 61 radiotherapy centres are equipped to provide both modalities but fewer than 10 are doing so regularly. Staff shortages, equipment capacity and sheer volume of routine work are given as reasons. Although fewer patients are aware of the advantages of these techniques than new drugs, the more sophisticated are now travelling considerable distances to receive optimal radiotherapy and opting for private care if necessary.
More than ever each individual cancer patient needs a friend – an experienced navigator in a sea of bureaucracy and chaos. Kate Spall has tirelessly served hundreds of patients to help them achieve optimal care within the NHS. Increasingly the attitude of those making funding decisions within the NHS is passive. If you don’t ask you don’t get. How you ask has assumed immense importance to the chances of success. Patient advocacy has never been more important than in 2010. By her work Kate is enhancing not just the quality of care for those she helps directly but also the lives of many other cancer patients. ”