Equality in access to cancer treatment: a crossroad in UK cancer services?

Introduction

In September 2011, The Lancet Oncology Commission released the report Delivering affordable cancer care in high-income countries.¹ This report highlighted a major issue facing people involved with planning, delivering, receiving and paying for cancer services in the UK: how can we afford to deliver high-quality and equitable care? This issue affects all countries, and difficult decisions have to be made in determining policy, providing services and paying for the rapidly evolving cancer care pathways. We also need to assess the potential effect these decisions have on equality of access for patients.

 

Media misunderstandings

The overall message of the report is that we can afford to deliver outcome-driven high-quality cancer care, but only by making fundamental changes to how we think of, and measure, the concept of “value” applied across integrated care pathways. However, the media have focused mainly on one aspect of the report, with emotive articles stating that cancer specialists believe spending money on high-cost cancer drugs at the end of life is futile.^2,3 Few people who have read the report in its entirety agree with this interpretation. Although we may baulk at the use of the term futile, what the report actually highlights is that a substantial proportion of the total spend on cancer care is delivered in the last weeks or days of a patient’s life, and that much of this care, such as chemotherapy, is futile. Such treatment may potentially be in conflict with the patient’s wishes and can have a detrimental effect on quality of life. Providing futile disease-directed care can “distract from a focus on palliative care that can improve quality of life and even prolong survival”.¹ The media reports do not recognise that end-of-life care involves a range of active options other than chemotherapy, and that the focus should be on what delivers the best qualityof- life outcomes for patients and their families. In this context, the report refers to “cancer care” not cancer drugs specifically. It is also patient-centric and makes an important distinction between endof- life management and palliative care, a distinction that is missed in most media reports. We need to ensure that the key messages of this report are not misrepresented and that attention is not diverted away from the crucial question: how to ensure that cancer care in the UK is built around equality of access to treatment that provides the best outcomes within an affordable framework to maximise value both to society as a whole and individual patients.

In my discussions with clinicians and service managers, it is clear that their focus is on the issues of enabling equality of access to care that delivers the best possible outcomes (in its wider context) and delivering quality care pathways within an affordable budget. Our concept of what “value” and “outcomes” mean to patients, society and the NHS is fundamental to the direction we choose to take with cancer care in the UK.

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