Listening to the news about NICE turning down yet another cancer drug has made me very sad and a little puzzled. In the space of 10 days two new drugs - Kadcyla and Abiraterone, that would give valuable extra time to breast and prostate cancer sufferers respectively, have been refused because of cost. There is much debate about how pricing is set and the criteria used to approve a treatment for the NHS.
Both these drugs display impressive characteristics and extend life in the patients taking them - and whilst Abiraterone is given to some men who have already had chemo, the option to take something that not only extends your life but doesn't make you feel ghastly, as is the case with most chemotherapy and radiotherapy treatments, should be available to all patients not just those who get funded through the Cancer Drugs Fund or who are wealthy enough to pay for the drugs themselves.
Earlier in the year, we watched a dear friend succumb to Throat Cancer after 2 years of fighting. The last 3 months were dreadful for him as he underwent one last ditch attempt at chemo to give him some precious extra time with his family; extra time that he ended up spending mostly house-bound and in his final days bed-bound like many terminally ill patients. If he could have been given an alternative, something that didn't make him feel so ill or that gave him that extra time, but without compromising his immunity so that he ended up battling his own body, I know he would have moved heaven and earth to get his hands on it.
The big question for me is - what price do you put on a life? It is an impossible moral and ethical dilemma for anyone having to make the decision but as someone who works in the cancer research sector, I find myself thinking about what we do and why we do it.
As a non-scientist responsible for fundraising for the John van Geest Cancer Research Centre at Nottingham Trent University, I work alongside inspirational colleagues whose dedication to the cause is humbling, but we are all involved because we want to make a difference.
The biomarkers and diagnostic techniques we are working on will one day lead to more immunotherapies and vaccines coming into the market; particularly in the field of breast and prostate cancer, where every year 22,000 men and women die annually in the UK alone. These treatments will help to extend life, and with a reasonable quality of life, if only patients are given access to them.
I have several very close girl friends who have survived breast cancer in the last decade, they were 'lucky' as the disease was caught early enough and they had a type that responded to one of the several treatments currently available. But not all women are that fortunate, there are still many variants of the disease that we are just scratching the surface with, or the type has been identified but the viable gene or biomarker that might lead to a vaccine is only at the beginning of a long road of clinical trials.
The cost of producing these drugs is enormous, but in general terms immunotherapies will likely be more cost effective than some of the traditional drugs. It can take up to a decade to get a vaccine through the various hoops to approval and into the market and the organisations involved in this process quite rightly need to see some sort of return on investment if the research is to continue.
There is an important flipside to all this research, and that is the development of improved diagnostic techniques. Much of our work is translational, helping to identify cell behaviours and new cancer sub-types and the tests we use can often be delivered into the clinic in a much shorter time frame than the trialling of a new vaccine. So people are benefiting from all this research in many different ways.
Cancer is a complex disease that will never be treated with one 'silver bullet'. Each type and sub-type has to be identified and an appropriate treatment developed - these new treatments will only ever work on the particular subset of patients that they are developed for and; that is the nature of the disease, so personalised medicine is the goal for the future. However they all have to be priced accordingly and will factor in production and marketing costs, on top of the cost to cover the years of research and development. Clinicians have to decide from the range of treatments available what is the most effective way forward for each patient, they don't always take decisions that appear to make sense and often leave some people the wrong side of the 'fence'.
Sadly this stand-off between NICE and the big drug companies is likely to continue for some time - more's the pity for the patients.