(10 years, 9 months ago)
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Eric Ollerenshaw (Lancaster and Fleetwood) (Con)
Thank you, Mr Deputy Speaker. As one Lancastrian to another, let me say that I am pleased to introduce this debate on access to new treatments for pancreatic cancer. It will become apparent why we are so pleased to get this debate at this time.
I want to start by reiterating some points I made about this dreadful disease in a debate in Westminster Hall last May that might help to set the context for this further debate today. Before I do, may I put on record my thanks to Pancreatic Cancer UK, Pancreatic Action, the all-party group on pancreatic cancer and others who have highlighted the impact of this disease? These include that great Lancastrian actress Julie Hesmondhalgh, who recently gave the disease some publicity in “Coronation Street”. More sadly there is the example of Kerry Harvey, who died at the age of 24 on 22 February and did so much in her last months to highlight the impact of this disease with the assistance of Pancreatic Action.
Pancreatic cancer is the fifth most common cause of cancer death in the UK. Approximately 8,500 people will be newly diagnosed with pancreatic cancer this year with around 7,900 people dying from the disease annually. Pancreatic cancer has the lowest survival rate of the 21 most common cancers. Five-year survival rates are less than 4%; a figure that has barely changed in nearly 40 years. Pancreatic cancer five-year survival rates lag behind many other EU countries and are almost half of what they are in the US, Canada and Australia. Only 1% of the National Cancer Research Institute Partners' total research spend is directed towards pancreatic cancer. By way of comparison, £3,613 per death per year is spent on breast cancer research compared to £553 per death per year on pancreatic cancer.
Some 50% of pancreatic cancer patients are diagnosed as a result of emergency admission—nearly twice that of all other cancers combined. Patients diagnosed as a result of emergency admission, compared to other routes to diagnosis such as routine GP referral, have significantly lower rates of survival. Pancreatic cancer patients have one of the least satisfactory NHS experiences of all cancer patients, evidenced by National Cancer Patient experience surveys.
If it is not too presumptuous, I would like to quote myself from the debate on 23 May 2012:
“Effective cures for pancreatic cancer remain stubbornly elusive, but we need to try to find ways to prolong patients' lives and to ease their pain and sufferings while always remembering that, with cancer, it is not only the patient who is affected but the people around them, including their family.”—[Official Report, 23 May 2012; Vol. 545, c. 93WH.]
The all-party group then found out that a new drug, Abraxane, in combination with standard chemotherapy was licensed for use in patients in the UK and Ireland with metastatic pancreatic cancer. Abraxane has been described as the biggest advance in pancreatic cancer treatment in almost two decades—for a disease, as I have already said, where survival rates have barely changed in 40 years.
As the drug has not yet been approved by the National Institute for Health and Clinical Excellence, it is not yet available on the NHS as a standard treatment. Pancreatic Cancer UK is very keen to ensure that patients are able to access Abraxane through the cancer drugs fund. The House will now see the importance of the debate tonight: the decision will be taken on Thursday 6 March—that is this week. Along with others in the Chamber, I would like to see the drug approved by the CDF this week and then eventually by NICE so that access to it is more readily available. We know that Abraxane is due to be reviewed by NICE very soon but this process takes a great deal of time, and it is time that pancreatic cancer patients do not always have.
One of my fears is based on my understanding of the way these new drugs are measured. This is based partly on what is called quality-adjusted life years which, so far as I understand it, is a measurement of the state of health and how long life is prolonged running from optimum health to death.
Jim Shannon (Strangford) (DUP)
I thank the hon. Gentleman for giving way and for bringing this important matter to the House’s attention. It is surprising how many of us know people, both personally and from our constituencies, who have been affected by pancreatic cancer. I have some figures from Northern Ireland that might help his argument. Only 14.2% of males and 10.3% of females live longer than a year after diagnosis. When we get to five years, those figures drop to 2.8% and 2.9% respectively. Early diagnosis is key, along with new treatments. That would increase the survival rate by 30%. Does he agree that a strategy covering all the regions of the United Kingdom of Great Britain and Northern Ireland would be better for addressing the issue?
Eric Ollerenshaw
The hon. Gentleman hits the nail on the head. It is of course a UK issue, and one of the concerns is the regional variation in performance on early diagnosis and the impact that is having. We want to get rid of that.
I want to talk today about the new drug Abraxane. The vast majority of pancreatic cancer patients are diagnosed so late that the benefit of any new drug can be measured only in months, rather than years. Our worry is that, compared with other cancers, that benefit might be deemed insufficient simply because it is measured in months and might not register highly on the quality-adjusted life years measurement scale.
That is why Pancreatic Cancer UK launched its Two More Months campaign, which highlights what patients would have been able to do with two more months, which is the average additional survival time provided by Abraxane. I have a few quotes from relatives of those who have died from pancreatic cancer:
“Two more months would have been a significant amount of time for Nicola, only 25 years old herself, to spend with her four year old daughter”.
That was from Chris, Nicola’s brother.
“Two more months would have meant my daughter Gemma might have got to wear her wedding dress and walk down the aisle with Adam”.
That was from Debbie, Gemma’s mum.
“Two more months would have seen my wife Jill finish her Open University Modern Languages degree and attend an international social work conference in Buenos Aires, both of which she would have been very proud of”.
That was from Dave, Jill’s husband.
“Two more months would have seen Andy and I celebrate our second wedding anniversary, and given us more time to prepare for what was to come”.
That was from Lynne.
For me, two more months would have meant one last Christmas with my partner—
Stuart Andrew (Pudsey) (Con)
May I pay tribute to my hon. Friend, who has done tremendous work on this issue and been a great advocate for all those affected by pancreatic cancer? I know from my experience of working in the hospice movement that time is the thing that all patients want. If that drug can provide just a little more time, surely it is something that all those families should be given.
Guy Opperman (Hexham) (Con)
I congratulate my hon. Friend on securing the debate and endorse what he says entirely. Does he agree that perhaps we should also consider going commando this Friday to raise male cancer awareness and show our general support for all cancers that people are struggling with today?
Eric Ollerenshaw
I am grateful for those well-timed interventions from my colleagues across the frontier.
What I am trying to get on the record is the fact that those two more months are critical in this particular cancer. Our worry is that two more months might not look good enough when the judgment is made, but for pancreatic cancer it is a massive improvement.
I also want to put on the record two other emerging possibilities. A useful and emerging new technology is NanoKnife. It carries out a process called irreversible electroporation, which destroys parts of the tumour while avoiding damage to vital tissue nearby, such as blood vessels. The process shrinks the tumour to a more manageable size, which might then allow more permanent surgical solutions. NanoKnife is currently available only through the private sector at one hospital in London.
A company called Novartis, has a treatment for neuroendocrine pancreatic cancer that is currently funded via the CDF in England. Although it is welcome that patients can access treatment via that route, we continue to argue for a long-term solution. In that context, we are worried about Andrew Dillon’s statement that, under the new system of value assessments that NICE is due to introduce in the autumn, only six out of 20 treatments assessed by NICE in the past year would be approved. A 30% approval rate is clearly not the long-term solution expected from the original concept of value-based pricing. In 2013, I understand, not one new cancer drug was approved by NICE. That issue, perhaps, is for a wider debate, but I hope the Minister understands that those arguing on behalf of pancreatic cancer patients are extremely worried about ever getting the new drugs on to the system and available for wider use across, hopefully, the whole United Kingdom.
Minister, this debate has been an unashamed appeal for support—from the charities concerned, the all-party group, the survivors and all those who have been affected by pancreatic cancer through the loved ones they have lost. We do not want others to go through our tragic experiences.
Tessa Munt (Wells) (LD)
I congratulate the hon. Gentleman on securing this debate. I should like to pick up on what he said about NanoKnife—there is also CyberKnife and Gamma Knife. Those are all modern, stereotactic treatments for cancer. I hope that he agrees that we need to concentrate not just on the drugs but on those particular types of radiosurgery, which can make sure that people live longer if they are given the trials that they need.
Eric Ollerenshaw
The hon. Lady makes an important point. Our point is that because of the poor pancreatic cancer survival rates and its late diagnosis, which is the key, it always seems that the pancreatic cancer patient is last in the queue. The quality of life assessments do not look long enough to justify a new drug or new radiotherapy, as has been pointed out.
Again, I pay tribute to Pancreatic Cancer Action, which got a great deal of press from an advert, not used at the time, saying, “I wish I had breast cancer”. That was effective in raising publicity about the impact of pancreatic cancer.
I am trying to put whatever pressure the Chamber is capable of exerting on the cancer drugs fund when it makes its decision on Thursday and on NICE for what it does to follow. Providing Abraxane and an extra two months could help ease this year’s 8,500 tragedies and start the process of making up for 40 years of lost hope.
Nic Dakin (Scunthorpe) (Lab)
I congratulate the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this debate and setting the scene so well. Pancreatic cancer needs all our efforts if we are to make a difference. I pay tribute to pancreatic cancer patients up and down the land, including my good friend Sir John Mason, who is battling the disease, and all the families and friends of those with pancreatic cancer, as well as those working with and supporting them.
As the hon. Gentleman said, survival rates from the disease have not changed for 40 years. Abraxane gives the opportunity not only for two more months, but to bring about change and transform how the disease is dealt with in future. In the United States, there is already innovation in how the disease is being tackled. I hope that the people having to make these difficult decisions listen to this debate and take it into account when making the decisions in a proper and objective way. It is important that our voices echo those of people who are contacting us about the condition, including my constituent Maggie Watts who has assembled a petition of 45,117 names of people who are shouting for something to be done about this disease.
That is all I want to say; I wanted to add my support to that of the hon. Member the Member for Lancaster and Fleetwood with whom I have worked on the all-party parliamentary group on pancreatic cancer.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I congratulate my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this debate and leading it in the knowledgeable and able way that he has led other debates on this important subject. I will do my best to respond to his specific points, but there may be some that I will need to respond to after the debate.
It goes without saying that cancer is a terrible disease, and my hon. Friend spoke movingly of his experience, but all hon. Members know ways in which it has touched them and their families and friends. I pay tribute to the work that he and colleagues in the all-party parliamentary group on pancreatic cancer have done to raise awareness of the disease. Its excellent report, “Time to Change the Story”, does much to counter common misconceptions about the disease.
My hon. Friend drew the House’s attention again to the particularly poor outcome for people who get the disease and the challenges in diagnosis. If we could match the best survival rates in Europe we could save an additional 75 lives a year. Clearly, if we exceeded those survival rates, more people would be saved.
Before I tackle my hon. Friend’s specific point about Abraxane, it is worth giving the context of other work that the Government are doing to support earlier diagnosis. We committed more than £450 million in funding over the four years to 2014-15. Sadly, there is currently no easy way of detecting pancreatic cancer and it can be particularly difficult for GPs to detect and diagnose it, especially in its early stages. However, to try to address the situation, the Department helped to fund a six-month pilot with Macmillan Cancer Support of a cancer decision support tool for GPs to help them to identify patients whom they might not otherwise refer urgently for this suspected cancer. Evaluation of the pilot is under way, and if it is found to be helpful, we will work with NHS England actively to promote its use. That tool was highlighted at a recent parliamentary event that some hon. Members might have attended.
We need to do more about earlier diagnosis and public awareness of the symptoms, which are often limited. As is often the way, I suspect that the recent “Coronation Street” story line has done more than many public health campaigns could have done to raise awareness. Yet again, well done to our broadcasters for covering some difficult issues and providing through Hayley’s sad story some important health education. It has reached many people, and we thank them for that.
On Abraxane, I am obviously aware of Pancreatic Cancer UK’s Two More Months campaign, and I congratulate my hon. Friend on this particularly well-timed debate. I am fully sympathetic to his points. As he says, two more months can mean so much to those who are affected by this cancer, and he gave some moving examples. We do not associate the disease with younger people. Sufferers are predominantly older but, as he illustrated, many people suffer at a younger age. I thank those who contributed to the report details of loved ones they have lost. My hon. Friend bears witness to his own loss, which we feel keenly with him.
I listened to my hon. Friend’s request that the recently licensed drug Abraxane should be made available from the cancer drugs fund. As he says, in the light of new evidence from the manufacturer, NHS England’s cancer drugs fund expert clinical panel is reviewing its earlier decision not to add it to its national list. One criterion in the scoring tool used by the panel is evidence of a drug’s impact on quality of life, which is what my hon. Friend spoke about. While I cannot in any way pre-empt the panel’s decision, I can fully understand how important this will be to people with pancreatic cancer. I will ensure that NHS England is made aware of tonight’s debate and the very good attendance. As the hon. Member for Scunthorpe (Nic Dakin) said, that reflects the impatience of parliamentarians, on behalf of their constituents, to see progress on this issue, which we seem to have been stuck on for so long. I undertake to do that immediately in the morning to ensure that the information is with the panel ahead of its deliberations.
My hon. Friend will be aware that Abraxane has not yet been assessed by the National Institute for Health and Clinical Excellence. Partly because of these situations, we established the cancer drugs fund to ensure that cancer patients in England have better access to life-extending or life-improving drugs that are not routinely funded by the NHS. He may also be aware that Novartis’s drug Afinitor is included on the national list for the cancer drugs fund, alongside two other treatments for treating pancreatic and neuro-endocrine carcinomas. More than 44,000 patients have benefited from the cancer drugs fund since October 2010, and we have recently announced an extension to funding for the scheme.
Looking further ahead, NICE is appraising Abraxane for untreated metastatic pancreatic cancer and expects to publish its guidance to the NHS in January 2015. That may seem a long way away, but, as been mentioned, this reflects the robust, evidence-based technology appraisal programme that NICE provides to ensure that clinical effectiveness and cost-effectiveness is taken into account when we look at drugs and treatments. The Government believe that clinically appropriate drugs should be routinely available to NHS patients, and we remain committed to the rapid uptake of NICE-recommended drugs in the NHS.
My hon. Friend referred to recent decisions on cancer drugs made by NICE. I am sure he appreciates that there will naturally be fluctuations in the proportions of drugs recommended by NICE each year, so a more accurate picture can be gained from looking at all NICE decisions on cancer drugs to date. That shows that almost two thirds of its decisions on cancer drugs have recommended their use for all or some of the eligible patient population. Far from making appraisals tougher, the most significant change to NICE technology appraisal methods in recent years has been to introduce greater flexibility in the appraisal of potentially life-extending treatments for patients at the end of their lives, and that has helped NICE to recommend a number of new cancer drugs for use on the NHS. That speaks directly to the extremely pertinent points that my hon. Friend made about how someone who has had such a diagnosis will see an extra two months in the context of the end of life, given that the progress of the disease can be very rapid from the point of certain diagnosis.
Jim Shannon
In an earlier intervention I asked about a UK-wide strategy. Has the Minister considered that for all the regions?
Jane Ellison
The hon. Gentleman has made that point in other contexts before, and it is a perfectly good one. Of course, health is a devolved matter, but as regards research and what we know about drugs, there are lots of aspects on which England has taken a lead and on which the devolved Administrations co-operate. I regularly have exchanges of letters with my opposite numbers. When there are important lessons to be learned on behalf of all our constituents, we would naturally share that information and expect it to be looked at in all parts of our United Kingdom.
Our priority is to make sure that we get the best possible results for all NHS patients with the resources we have. That is why we have asked NICE to look at how drugs are assessed to ensure that patients can get the treatments they need at the best value for the NHS, and that the price the NHS pays is more closely linked to the value a medicine brings. These can sometimes sound like quite cold decisions, but they are designed to help us to have a sense of objectivity in what are always very difficult decision-making processes. I assure my hon. Friend that NICE will carry out a full public consultation before implementing any changes in the way that it makes these assessments.
My hon. Friend referred to NanoKnife, which was also mentioned in an intervention. I am advised, I am afraid, that NICE has published guidance on that procedure which states that current evidence on the safety and efficacy of irreversible electroporation for treating pancreatic cancer is inadequate in quantity and quality, and it recommends that the procedure should currently be used only in the context of research.
My hon. Friend mentioned research funding. We are often asked about the amount of funding put into one area or another and I always like to make the point that, rather than specifying subject areas, the National Institute for Health Research welcomes funding applications for research into any aspect of human health. These applications are subject to peer review and are judged in open competition, with awards made on the basis of the importance of the topic to patients and the NHS, value for money and scientific quality.
I have no idea whether parliamentary interest is part of that mix, but I cannot believe that it hurts at all. Such issues come up regularly, and whenever I meet people from different health institutions and the NHS I always make a point about the things in which Parliament has shown a particularly keen interest to debate and progress.
Jane Ellison
I do not think I have time, sadly, but I would be happy to speak to my hon. Friend after the debate.
I hope it will be of interest that the Government are investing a record £800 million over five years in a series of biomedical research centres and units, including £6.5 million of funding for the Liverpool biomedical research unit in gastrointestinal disease, which has a major focus on pancreatic cancer. Some really interesting things are coming out of the opportunities for biomedical centres.
Recruitment to studies associated with pancreatic cancer by the NIHR clinical research network has also increased more than fivefold, from 447 in 2008-09 to 2,744 in 2012-13, which is another measure of the increased emphasis and interest.
I again pay tribute to my hon. Friend the Member for Lancaster and Fleetwood for his campaigning on this issue and the work he has done to raise its profile in Parliament, and to all hon. Members for the interest they have shown. As I have said, it is great to see such good attendance at this debate. That is on the record and it is of great interest.
Tessa Munt
Do NICE and similar organisations accept reviews and evidence from other countries, be they in Europe or America, when they deliberate and make considerations, or is it only home-grown evidence that counts? Is there an acceptance of the views of clinicians from other parts of the world?
Jane Ellison
I will, if I may, take my hon. Friend’s question away and respond to it formally. Obviously, it is a matter for NICE and I will make sure that I get an answer for her. My understanding, however, is that an awful lot of peer-reviewed research from all around the world is looked at and that it is the quality of that research that is taken into account. I will respond formally to my hon. Friend and make sure that I have that absolutely right.
In conclusion, I thank those who have participated in this important debate and those who have stayed to show their support for it, which is valuable. This disease remains very difficult to treat, but the Government will continue to work with patients and charities—which have done so much good work—and with researchers, the pharmaceutical industry and, of course, the NHS to improve results for people with pancreatic cancer and to see whether we can make more rapid progress than we have made in the past four decades.
Question put and agreed to.